Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Dissection of the Tumor and Reopening of Previous Surgical Cavity

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This video shows lateral ventricle entry, dissection of tumor from internal cerebral vein, debulking of the tumor, and entry into the previous surgical cavity.

Keywords

  • Callosotomy
  • Corpus callosum
  • Tumor
  • Internal cerebral vein

About this video

Author(s)
Giuseppe Cinalli
Matteo Sacco
First online
16 March 2019
DOI
https://doi.org/10.1007/978-3-030-16006-7_14
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

After a very careful dissection, we finally identify the plan of the section that is best in order to lead us to the– in a previous surgery, here is the plan that has finally allowed dissection of the tumor and opening of the previous surgical cavity. This is the plan. Finally, we identified the yellowish tissue of the gliotic areas that surround the tumor.

We, after identification of this dissection plan, we proceed much faster in order to dissect farther procedurally the pericallosal artery, identify the tumor, identify, if possible, also the internal cerebral vein that begins to appear on the edge of the tumor.

And the tumor tissue is fortunately very easy to identify here. We can dissect on the right the right internal cerebral vein. It looks very different, but in fact, a careful dissection allows the identification of the right internal cerebral vein very nicely. And this vein can be dissected quite easily from the tumor tissue simply with the Rhoton dissector and a standard microsurgical sucker.

We reposition the self-retaining retractor and we continue in the internal decompression until we reach the cavity of our previous surgery. And, of course, this facilitates our identification of the anatomy. Here, we can identify the previous cavity in the right internal cerebral vein and we continue after identification of the cavity in removing the tumor tissue and dissecting the tumor from the neural structures that look infiltrated.

But in fact, fortunately, in this case, in spite of the previous surgery, we can identify a plan of dissection that is quite easy to follow that allows a progressive reduction of the tumor mass that is quite related, shrink it with the bipolar, and can be removed piecemeal after careful dissection of the cell capsule from the neural tissue.