Combined Staged Telo-Velar and Trans-Choroidal Approach to a Tumor of the Sylvian Aqueduct

  • Giuseppe Cinalli
  • Nicola Onorini

Your browser needs to be JavaScript capable to view this video

Try reloading this page, or reviewing your browser settings

You're watching a preview of subscription content. Log in to check access

The video describes the staged resection of a midbrain ganglioglioma with double extension into the third and fourth ventricle, using a combination of two surgical approaches, one of them rarely performed, especially for aqueductal tumors.

The lesion had been diagnosed and treated four years before in another institution, but the tumor grew over the time and the pediatric patient was referred to our department for surgical treatment.


Due to the tumor dumbbell appearance, one-stage resection was considered too dangerous and therefore a staged resection in two procedures was planned. Telo-velar approach allowed for removal of approximately 2/3 of the lesion; histology revealed a ganglioglioma. After multidisciplinary discussion, it was decided that radical removal should be attempted instead of radiotherapy. Interhemispheric transcallosal transchoroidal approach was therefore performed, allowing for complete removal without neurological sequelae. RI performed after the second procedure showed a nearly total removal of the ganglioglioma, and no residual tumor or regrowth at three-year follow up. The different steps of the two approaches are described and commented in details in the video

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 at the University of Milan, working in the Department of Neurosurgery of University of Brescia.


About this video

Giuseppe Cinalli
Nicola Onorini
Online ISBN
Total duration
33 min
Springer, Cham
Copyright information
© The Author(s) 2020

Video Transcript

[MUSIC PLAYING] This video describes the combined-staged telo-velar and trans-choroidal approach to a tumor of the Sylvian aqueduct. I am Giuseppe Cinalli, Director of Pediatric Neurosurgery at Santobono-Pausilipon Children’s Hospital in Naples, Italy.

The video describes a staged resection in two procedures of a mid-brain ganglioglioma growing into the Sylvian aqueduct, bulging downward into the fourth ventricle and upward into the third ventricle. The lesion had been diagnosed four years earlier due to hydrocephalus that had been treated with a endoscopic third ventriculostomy at another institution. The tumor grew over the years, and the patient, a 13-year-old girl, was referred to our department for surgical treatment.