Interhemispheric Transtentorial Approach to a Teratoma of the Pineal Region

Dissection of the upper pole

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The tumor is dissected from the vein complex.

Keyword

  • Vein of Galen

Conflict of Interest

The author declares no conflict of interest.

About this video

Author(s)
Giuseppe Cinalli
Marcello Barbato
First online
08 January 2022
DOI
https://doi.org/10.1007/978-3-030-95496-3_8
Online ISBN
978-3-030-95496-3
Publisher
Springer, Cham
Copyright information
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022

Video Transcript

We continue now with the dissection of the upper pole. We can identify, again, the dissection plan between the capsule and the upper part of the brain tissue that is compressed by the tumor. This part of the surgery, of course, is delicate because sometimes the relationship with the big veins, like the vein of Galen, and possibly the internal cerebral veins, can be very intimate.

So a dissection plan is very important to find. And distinguish the veins that can be sacrificed because they are coming from the tumor. And the veins that must be respected and that are part of the deep-vein complex is the key part of the surgical procedure, of course.

Here we can see that, fortunately, the dissection plan is relatively easy to find and easy to respect throughout the procedure. This vein that is crossing our field is, at the moment, under evaluation. We consider the destination of this vein, we consider the relationship of this vein, and we continue for the moment with the dissection of the easier part of the tumor that can be dissected because the relationship with the smaller veins are extremely evident.

Here, you can see the small fibrous band that keeps the tumor attached to the neural tissue. And the deepening our dissection at this point below the vein that we were evaluating in the upper part of the surgical field is of utmost importance, of course, in letting us understand what is the dissection plan, what is to be respected, and what can be possibly sacrificed to progress with our dissection.

Here, you can see that we are changing our instrumentation and the orientation of the microscope. And you see that this work of progressive dissection is really key in obtaining a perfect identification of structures to respect and the structures to sacrifice. And here, the key point is to reach from the upper part of the tumor the cavity of the third ventricle.

This is very, very important because at this point, we are sure that we have completely freed our upper pole and right-lateral aspect of the tumor. We can separate definitively the tumor from the remaining adhesions in the lower part. And we can continue our dissection.

We are trying to understand, what is the dissection plan at this level? Now it is more clear. And this part of the tumor, of course, is attached. And we prefer to coagulate this band that keeps the adhesion between the tumor and the neural tissue, and we separate completely this right-upper part of the tumor.