Transchoroidal Approach to Tumors of the Posterior Third Ventricle

  • Giuseppe Cinalli
  • Nicola Onorini

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The video describes the surgical strategy for approaching a large mass located in the posterior half of the third ventricle occluding the sylvian aqueduct and causing significant obstructive triventricular hydrocephalus in a 10-year old girl. Hydrocephalus was treated first with an endoscopic third ventriculostomy, and an attempt to biopsy the tumor failed due to hemorrhage from the lesion. It was therefore decided to approach the tumor directly with the aim of the maximum possible safe removal.

Introduction

The three main surgical options are presented: The transcallosal/transforaminal route, the posterior interhemispheric/transtentorial route and the anterior interhemispheric transcallosal/transchoroidal route. The respective advantages and disadvantages of the three approaches are discussed and the reasons for ultimately selecting the transcallosal/transchoroidal route are explained. The rationale for choosing this approach comes from a careful analysis of pre-operative MRI scans on high definition sagittal images, which show how the tumor is located at the entrance of the sylvian aqueduct, whose inlet is extremely dilated, assuming a wide funnel shape. A post-operative MRI shows near total removal of the tumor, which the histology confirmed as pilocytic astrocytoma.

About The Author

Giuseppe Cinalli

Dr. Giuseppe Cinalli is Chief of the Department of Pediatric Neurosurgery and of the Department of Neurosciences at the Santobono-Pausilipon Children’s Hospital, where he began working in October 1999. He started the residency program in Neurosurgery at the “Federico II” University in Naples, and completed it at the Department of Pediatric Neurosurgery of the Hôpital Necker Enfants Malades in Paris, France. In 1993 he spent a period as a visiting fellow at the Department of Pediatric Neurosurgery of the New York University Medical Center directed by Fred Epstein, and at the Department of Pediatric Neurosurgery of the Primary Children’s Medical Center of Salt Lake City directed by Marion “Jack” Walker. In the same year he began his University career in France as Chef de Clinique-Assistant and later as Praticien Hospitalo-Universitaire. He is an active member of 7 scientific societies, has written 116 indexed papers, edited 4 books, and is a founding member of the International Study Group on Neuro Endoscopy (ISGNE), which later became the International Federation of Neuroendoscopy (IFNE). In 2017 he was elected President of the IFNE for a two-year term.

 

Dr. Nicola Onorini is a resident in Neurosurgery at the University of Milan, working at the Department of Neurosurgery, University of Brescia.

 

About this video

Author(s)
Giuseppe Cinalli
Nicola Onorini
DOI
https://doi.org/10.1007/978-3-030-13673-4
Online ISBN
978-3-030-13673-4
Total duration
34 min
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

This video will show the transchoroidal approach to tumors of the posterior third ventricle. I am Giuseppe Cinalli, head of the pediatric neurosurgery at Santobono-Pausilipon Children’s Hospital in Naples, Italy. The case is of a ten year old girl admitted for intracranial hypertension with an MRI showing obstructive triventricular hydrocephalus due to a large mass located in the posterior half of the third ventricle occluding the sylvian aqueduct. Hydrocephalus was treated with endoscopic third ventriculostomy, and an attempt to biopsy the tumor failed due to hemorrhage from the lesion. It was therefore decided to approach the tumor directly for an attempt to maximum safe removal.

Post-operative MRI showed near total removal of the tumor. Histology confirmed as pilocytic astrocytoma. The patient did not develop any post-operative motor or memory deficit. A thin residual adherent to tela choroidea remained stable at two year follow up and did not require further treatment. The child follows a normal school and with a very good result.