Gross Total Removal of Gliomas in the Pulvinar and Correlative Microsurgical Anatomy.

Abstract

Tumors in the pulvinar tend to present as circumscribed lesions with exophytic growth into the lateral and third ventricles. These lesions may be best explored via a parietal-transcortical-transventricular approach. If the tumor extends posteriorly or inferiorly, a posterior-interhemispheric-transtentorial approach may provide a good angle of access. Gross total removal of the tumors in the pulvinar of two patients was achieved by surgical sectioning of the unilateral crus of the fornix or the splenium via a transventricular or interhemispheric approach with acceptable risk. These patients are now doing well as students about 6 years following the first operations. During tumor removal, a posterior-interhemispheric-transtentorial approach combined with above-mentioned approaches was useful for orientation of the critical structures in the posterior incisural space. Knowledge of the anatomical relationships of the pulvinar to the crus of the fornix and the choroid plexus, and to the critical structures located in the posterior incisural space is extremely important for neurosurgeons.

Microsurgical and endoscopic approaches to the pulvinar

“…It requires opening the choroidal fissure to expose the adjacent cisternal surface of the pulvinar. 14,17 The ventricular surface of the pulvinar may also be exposed before opening into the atrium since this approach is directed along the medial surface of the hemisphere. In this approach, the precuneus is allowed to settle away from the falx cerebri if the side of the lesion is placed downward.…”

Extraneural Metastasis of High Grade Glioma Without Simultaneous Central Nervous System Recurrence-Case Report-

“…7) A 12-year-old, right-handed boy was admitted with a 4-day history of headache and vomiting. His illness had started with diplopia 1 month earlier.…”

Avaliação anatômica, qualitativa e quantitativa das variantes do acesso supracerebelar infratentorial para o tálamo pósteroinferior

“…Em torno de 25% dos casos há exérese macroscópica total onde a qualidade de vida do paciente deve ser considerada e o tratamento individualizado. Quando há crescimento exofítico da lesão talâmica, o acesso, embora profundo, é facilitado permitindo a exérese adequada respeitando o caminho definido pelo tumor (48,49). Em determinados casos, biópsia e tratamento de hidrocefalia são os tratamentos neurocirúrgicos instituídos (47).…”