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Little, Kenneth M.; Friedman, Allan H.; Fukushima, Takanori

doi:10.1023/a:1012766902431

Cited by 57 publications

(8 citation statements)

References 62 publications

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“…Surgery of pineal region pathology is difficult due to the limited access in a small and deep corridor. This is highlighted by the numerous approaches that can be utilized to performed microsurgery in this region [ 2 - 3 , 9 - 11 ]. The literature has established benefits and limitations for each approach.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note

Felbaum¹,

Syed²,

Ryan³

et al. 2016

Cureus

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Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions.A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud’s syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection.A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection.The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain.The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal resection of a traditionally difficult pineal region tumor. Further experience with this combined technique may allow for improved surgical outcomes for these complex lesions.

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Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note

Felbaum¹,

Syed²,

Ryan³

et al. 2016

Cureus

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“…When a pineal region meningioma grows bilaterally to the tentorial plane and extends laterally, the large variation of the tentorial angle will result in a complicated anatomical relationship between the tumor, the tentorium and the falx [13]. …”

Section: Discussionmentioning

confidence: 99%

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Zhao

Wang

et al. 2011

World J Surg Onc

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BackgroundThere are several treatment approaches for pineal region meningiomas, such as Poppen's approach, Krause's approach and combinations of the two approaches. We present our experience with the use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using a suboccipital transtentorial approach (Poppen's approach) and evaluate the role of Poppen's approach.MethodsDuring the period from January 2005 to June 2010, ten patients presented to us with pineal region meningioma. MRI was routinely used to define the tumor size, position, and its relevant complications while 3D-CTA was applied to define the blood supply of the tumor and the venous complex (VC) shift before operations. Most of the meningiomas had developed at both sides of the tentorial plane and extended laterally with typical characteristics of a pineal region tumor.ResultsAll tumors were completely removed surgically without any injury to the VC. Postoperative intracranial infection occurred in one case who recovered after antibiotics were given. Postoperative intraventricular hemorrhage and pneumocephalus were found in one case, but fully recovered after conservative treatment. In the nine cases of concurrent hydrocephalus, this was gradually relieved in eight patients and the single case that became aggravated was successfully treated with ventriculoperitoneal shunt. Moreover, the follow-up MRI examinations did not indicate any recurrence of the meningiomas.ConclusionWe found that the use of Poppen's approach is strongly supported for the successful removal of pineal region meningiomas without serious complications.

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“…The patient can be positioned either in a sitting or prone position. After the midline suboccipital craniotomy and dura opening, the bridging veins between the cerebellum and the tentorium, as well as the precentral cerebellar vein, can be sacrificed; however, the lateral dorsal cerebellar bridging veins and petrosal veins should be protected due to the risk of postoperative cerebellar venous congestion and swelling [56]. The arachnoid membranes overlying the pineal region are thickened, and careful dissection is required to avoid injury to the vein of Galen, basal veins of Rosenthal, and the ICVs.…”

Section: Third Ventriclementioning

confidence: 99%

Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions

et al. 2016

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Tumors of the lateral and third ventricles are cradled on all sides by vital vascular and eloquent neural structures. Microsurgical resection, which always requires attentive planning, plays a critical role in the contemporary management of these lesions. This article provides an overview of the open microsurgical approaches to the region highlighting key clinical perspectives.Electronic supplementary materialThe online version of this article (doi:10.1007/s11060-016-2126-9) contains supplementary material, which is available to authorized users.

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Untitled

Cited by 57 publications

References 62 publications

Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note

Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions

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