Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Third Ventriculostomy

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This video shows how the floor of the third ventricle is perforated. A post-operative MRI shows very small residual under the corpus callosum adherent to the roof of the left lateral ventricle.

Keywords

  • Mammillary bodies
  • Basilar artery
  • Tuber cinereum
  • third ventriculostomy
  • 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_21
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

This can be very easy to perform, but in fact, when the target is so far away, that we have to be very careful because we have to work very close to the basilar artery. And we cannot use a sharp instrument at this time. And certainly, the best instruments to perform a microsurgical third ventriculostomy is a smooth, right-angle hook that can take the floor– perforate the floor– and open the perforation in a very atraumatic way. And with the use of the microsurgical aspirator, and with the use of the right-angle hook, we can perform a very acceptable opening in the floor of the third ventricle, a very nice microsurgical third ventriculostomy to allow communication between the third ventricle and interpeduncular system. And we can close, finally, the approach of the interhemispheric fissure.

After the third surgery, post-operative MRI showed a small but measurable tumor nodule in the left-lateral ventricle just below the corpus callosum. Because of the very favorable clinical evolution of the possibility to achieve a really total removal with a minimally invasive procedure, a final endoscopic procedure was performed four days after the previous one.

The volumetric images with the MRI shows that the small nodule into the left lateral ventricle in the very upper part of the ventricle. And we can identify it just below the corpus callosum. The coronal section confirms that the last nodule is evident just below the corpus callosum. And it is also easily and well identified by the surgical T2 section.

So the trajectory is scheduled from a frontal borehole in order to be perfectly in the axis of the tumor– residual tumor– to remove that is very small. And the [? fourth ?] surgery finally is the endoscopy removal of this small residual tumor.