Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Left Interhemispheric Approach and Post-Operative Period

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This video shows the dissection of the interhemispheric fissure on the left side of the falx to better approach the left ventricle component of the tumor.

Keywords

  • Falx
  • Interhemispheric fissure
  • Left ventricle
  • Tumor dissection
  • Post
  • operative MRI
  • Tumor residual
  • Post
  • operative period

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_16
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

Left interhemispheric approach becomes necessary when a division of the left side is reduced. And at this point, we open the dura. And we start to dissect the interhemispheric fissure on the left side of the falx, opening the surgical cavity, and finding the tumor residing in the left lateral ventricle with a better angle of vision.

The surgical cavity is immediately found in the depth of the interhemispheric fissure. The dissection is easier on this side, if compared to the contralateral side because of the presence of a large surgical cavity already done by the previous part of the surgical procedure.

And on the left side, also, we start the dissection of the tumor from the venous structures and from the neural tissue. And we have as visible a much better angle of vision of this intraventricular part of the tumor.

We can debulk very effectively this huge component of the left intraventricular part of the tumor. And as you see, the bleeding is still quite significant at this time of the surgery. And we proceed carefully always with the ultrasonic aspirator debulking the tumor in the middle very slowly. As you can see, the surgical aspirator remains superficial in order to avoid the risk of becoming too deep with our instrument.

And after a significant debulking, we can proceed to the dissection of the most posterior part of the tumor in the left intraventricular space. And we can piecemeal remove this most posterior part of the tumor. And we can easily reduce the volume of the tumor at this time, even after significant use of Surgicel because of important bleeding occur at this time.

The plan of dissection is, in this point, easy to find. Fortunately, the plan is really very evident. Sometimes thick adhesions have to be cut sharply with the micro scissors. But progressively, the plan of dissection is deepened posteriorly and in the inferior part of the surgical cavity on the left side. And we can achieve very significant progress in tumor removal at this time.

In the second post-operative period, the post-operative MRI showed a residual tumor in the posterior part of the lateral ventricle and in the third ventricle. The intended goal of complete removal of the tumor, therefore, was not achieved yet. The clinical evolution was uneventful. The patient recovered rapidly after the second procedure. And so a third procedure was scheduled after three weeks to complete the removal of the tumor.