Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Endoscopic Removal of a Small Residual Tumor Nodule through a Left Frontal Approach

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In this video segment, the residual tumor is completely removed through a left frontal bur hole with an endoscopic ultrasonic surgical aspirator.

Keywords

  • Endoscope
  • Endoscopic Ultrasonic aspirator

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_22
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

After introduction of the endoscope, the ventricular cavity is explored, the CSF is, of course, not very clear because we are four days after the previous surgery. But finally, in close vision, the tumor is easily identified, and the remnant is identified as well with the electromagnetic navigator.

After identification, we can finally remove it very quickly, and very easily, and effectively with endoscopic ultrasonic aspirator Fortunately, this remnant is almost completely avascular, and the bleeding remains absolutely negligible and very easy to control with the simple aspiration offered by the endoscopic ultrasonic aspirator.

The technique of using the endoscopic aspirator is very simple, like, with the other Cavitron, we have to do very small movements of the cannula of the ultrasonic aspirator in order to mobilize progressively the tumor or tissue until we find the normal tissue that is easily identified at such close vision from the tumoral tissue.

And as you can see in a few minutes, we can achieve true, simple [INAUDIBLE], a complete removal of the small tumor remnant there [? into ?] the ependyma of the roof of the left-lateral ventricle. You see that we remain with the Cavitron on the surface of the neural tissue. We just aspirated a small layer of the tumor that infiltrates the ependyma. We just leave the surgical aspirator to work without excessive movements, but the simple aspiration and fragmentation of the tumor allows progressive and rapid cleaning of all the tumoral tissue that is remaining [? there ?] [? into ?] to the surgical bed in the upper part of the left-ventricular system.

You see that the [? Cavitation ?] power used in this procedure is very low because we don’t need a high-vibration power. We have to use the minimal effective power with every ultrasonic aspirator in order to reduce the vibration or reduce the possible damage to the neural tissue. It is really important to be patient and to progressively aspirate and fragmentate every single small nodule of tissue. And we can see at the end of the surgery a very nice final result with a good identification of almost normal ependyma at this level.