Endoscopic-Assisted Microsurgical Removal of a Tectal Plate Pilocytic Astrocytoma Through the Occipital Inter Hemispheric Transtentorial Approach: 2-Dimensional Operative Video

Abstract

Pilocytic astrocytomas are challenging benign midline lesions which occur rarely in adults where they represent 2.3% of the tumours. 1,2 Posterior fossa location is the most frequent, but they also can be seen in the brainstem, tectal plate, and optochiasmatic region. 1,2 Tectal plate location is very challenging and can be reached through a infraoccipital supracerebellar approach 1,2 or the occipital inter hemispheric transtentorial approach. We present the case of a 32-years-old patient who presented with acute hydrocephalus 2 years previously and was treated by third ventriculostomy in an outside institution. Follow-up showed slight increase of the tumor while the patient remained asymptomatic. Microsurgical treatment was offered to the patient given the size of the lesion, the progression of the tumor, and her young age. We present the main surgical steps of the surgery through an occipital interhemispheric approach with section of the tentorium. The lesion was removed piecemeal through the intercollicular sulcus. The postoperative course was favorable; at 3 months of follow-up, the patient showed no neurological deficit. Brain MRI showed a complete resection of the astrocytoma and no postoperative complications. We present the surgical technique for endoscopic-assisted microsurgical removal of a tectal plate pilocytic astrocytoma through the occipital inter hemispheric transtentorial approach. We discuss the prognostic survival factors reported in the literature. 2 The patient consented to the procedure and to the publication of the images. Our institutional review board ethics committee do not require an approval for this type of publication.