SURGICAL VIDEO Microsurgical Resection of Posterior Third Ventricular/Pineal Region Papillary Tumor Via Supracerebellar Infratentorial Approach: 3-Dimensional Operative Video Sima Sayyahmelli, MD, Ihsan Dogan, MD, Mustafa K. Ba¸skaya, MD Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy133 Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin Correspondence: Mustafa K. Baskaya, MD, Department of Neurological Surgery, University of Wisconsin Medical School, K4/834 CSC, 600 Highland Avenue, Madison, WI 53792-0001. E-mail: firstname.lastname@example.org The posterior third ventricle and pineal region can harbor outside hospital. The histopatology of the tumor was different pathologies. The supracerebellar infratentorial papillary tumor of the pineal region. The patient was approach allows a direct access to the pineal region and referred for further surgical resection due to enlargement posterior third ventricle and provides wide exposure of the of her tumor on follow-up radiological imaging. The arachnoid planes and deep venous system. surgery and the patient’s postoperative course were In this 3-dimensional video, we present a patient uneventful and the patient remained unchanged in the with posterior third ventricular/pineal region tumor who postoperative period. underwent microsurgical resection via supracerebellar The important steps of the surgical approach and micro- infratentorial approach. The patient is a 28-year-old surgical resection are demonstrated in this 3-dimensional woman with history of hydrocephalus who underwent surgical video. The patient consented to publication of her endoscopic third ventriculostomy and biopsy at an images. KEY WORDS: Papillary tumor, Pineal region, Posterior third ventricle, Supracerebellar infratentorial Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy133 Received, November 13, 2017. Accepted, April 26, 2018. his is a nice illustration of a pineal tumor resection via the suprac- Disclosure T erebellar infratentorial approach. The authors elegantly demonstrate The authors have no personal, financial, or institutional interest in any of the the technique and the key points of the procedure along with a wealth of drugs, materials, or devices described in this article. operative pearls. The authors are commended for their clinical and radio- graphic results. Although the prone position is currently utilized in the majority of the US for similar lesions, we continue to operate on similar cases in the sitting position. Patients are tested preoperatively to rule out patent foramen ovale and intraoperative monitoring is performed COMMENTS with precordial or transesophageal Doppler for early detection of air embolism. Regardless, these lesions are very challenging and the expertise he authors present 2 cases of pineal region/posterior third ventricle of the operating team with either sitting or prone position is paramount lesions. The supracerebellar approach is nicely depicted in the video and should not be underestimated. presentation and technical nuances and pitfalls presented. Kelly Gassie Carlos A. David Rabih G. Tawk Burlington, Massachusetts Jacksonville, Florida OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy133/4999295 by Ed 'DeepDyve' Gillespie user on 12 July 2018
Operative Neurosurgery – Oxford University Press
Published: May 18, 2018
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