Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video

Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video Abstract A 62-yr-old woman presented with incidentally detected left trigonal mass by magnetic resonance imaging (MRI) performed during workup for left-sided hearing loss and vertigo of 5-yr duration. Due to persistent dizziness, headache, and progressive enlargement of the tumor in follow-up scans, operation was planned. Because the tumor extended superiorly, a superior parietal lobule approach was selected. She underwent a left parietal craniotomy. A strip electrode was used to localize the motor and sensory regions, and neuronavigation was used to confirm the entry site. A small transsulcal corticotomy was performed posterior to a large cortical vein. The tumor was pinkish in color with a well-defined capsule. It was centrally debulked by using curettes, pituitary forceps, and the ultrasonic aspirator. Tumoral blood supply from the choroid plexus and the posterior choroidal vessels were cauterized and divided. Additional blood supply coming from the anterior choroidal vessels was also found and cauterized. After circumferential dissection of the tumor capsule, the tumor was removed completely. The pathology indicated WHO Grade I meningioma. The patient had mild expressive and receptive aphasia postoperatively, but improved progressively. The postoperative MRI showed total resection with no evidence of brain injury. At 3-mo follow-up, the speech was normal; she was independent for all daily activities, but had not yet returned to work (Karnofsky score 80). This 3-D video shows the technical nuances of microsurgical resection of an intraventricular tumor through a narrow brain corridor. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides. Microsurgical resection, intraventricular tumor, trigonal tumor Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy068 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy068 Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video Close COMMENT The authors present a wonderful 3-dimensional video about the microsurgical resection of a large trigonal tumor where a superior parietal lobule approach was selected. The transintraparietal sulcus approach, as in the reported case, offers a very elegant surgical corridor to the atrium of the ventricle carried out between the motor and visual pathways. The rationale of this approach over others consists in the full visualization of the choroid plexus vasculature from the plexal segment of the anterior choroidal artery in the temporal horn to the plexal segment of the medial and lateral posterior choroidal arteries within the body of the ventricle. This aspect allows the surgeon to achieve complete vascular control for any tumor, regardless of from which the blood supply comes. My congratulations to the authors for the beautiful and very clean surgery, as well as for the high teaching value of their video. Sabino Luzzi L’Aquila, Italy Copyright © 2018 by the Congress of Neurological Surgeons http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy068
Publisher site
See Article on Publisher Site

Abstract

Abstract A 62-yr-old woman presented with incidentally detected left trigonal mass by magnetic resonance imaging (MRI) performed during workup for left-sided hearing loss and vertigo of 5-yr duration. Due to persistent dizziness, headache, and progressive enlargement of the tumor in follow-up scans, operation was planned. Because the tumor extended superiorly, a superior parietal lobule approach was selected. She underwent a left parietal craniotomy. A strip electrode was used to localize the motor and sensory regions, and neuronavigation was used to confirm the entry site. A small transsulcal corticotomy was performed posterior to a large cortical vein. The tumor was pinkish in color with a well-defined capsule. It was centrally debulked by using curettes, pituitary forceps, and the ultrasonic aspirator. Tumoral blood supply from the choroid plexus and the posterior choroidal vessels were cauterized and divided. Additional blood supply coming from the anterior choroidal vessels was also found and cauterized. After circumferential dissection of the tumor capsule, the tumor was removed completely. The pathology indicated WHO Grade I meningioma. The patient had mild expressive and receptive aphasia postoperatively, but improved progressively. The postoperative MRI showed total resection with no evidence of brain injury. At 3-mo follow-up, the speech was normal; she was independent for all daily activities, but had not yet returned to work (Karnofsky score 80). This 3-D video shows the technical nuances of microsurgical resection of an intraventricular tumor through a narrow brain corridor. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides. Microsurgical resection, intraventricular tumor, trigonal tumor Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy068 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy068 Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video Close COMMENT The authors present a wonderful 3-dimensional video about the microsurgical resection of a large trigonal tumor where a superior parietal lobule approach was selected. The transintraparietal sulcus approach, as in the reported case, offers a very elegant surgical corridor to the atrium of the ventricle carried out between the motor and visual pathways. The rationale of this approach over others consists in the full visualization of the choroid plexus vasculature from the plexal segment of the anterior choroidal artery in the temporal horn to the plexal segment of the medial and lateral posterior choroidal arteries within the body of the ventricle. This aspect allows the surgeon to achieve complete vascular control for any tumor, regardless of from which the blood supply comes. My congratulations to the authors for the beautiful and very clean surgery, as well as for the high teaching value of their video. Sabino Luzzi L’Aquila, Italy Copyright © 2018 by the Congress of Neurological Surgeons

Journal

Operative NeurosurgeryOxford University Press

Published: Mar 30, 2018

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