Interhemispheric transcallosal transchoroidal approach to a pineal teratoma in a 15-year-old boy.

Giuseppe Cinalli,Alessia Imperato,Maria Rosaria Scala,Pietro Spennato,Giuseppe Mirone,Alessandra Marini

doi:10.3171/2021.4.focvid2126

Abstract

In this video, the authors present an interhemispheric transcallosal transchoroidal approach to a pineal mass in a 15-year-old boy. He received emergency endoscopic third ventriculostomy (ETV), then an endoscopic biopsy that revealed an immature teratoma. Surgical removal was selected. The mass was located very high in the posterior third ventricle, hidden behind the splenium of the corpus callosum and the vein of Galen, so an interhemispheric transcallosal approach followed by a complete dissection of the whole choroidal fissure was chosen and allowed complete removal of the tumor. Microsurgical dissection is presented, showing clearly in detail all the neurovascular structures encountered.The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2126.

Highlights

We present an interhemispheric transcallosal transchoroidal approach to a pineal teratoma in a 15-year-old boy
The mass was located very high in the posterior third ventricle hidden behind the splenium and the vein of
The occipital interhemispheric transtentorial (OITA) approach would allow excellent control of the lower half of the tumor, but the upper half would remain hidden behind the splenium and the vein of Galen. 3D model showing the Herophilus-Galen line helps to understand how deep and hidden is the tumor behind the Galen complex without improvements of vision moving the microscope

Summary

Introduction

We present an interhemispheric transcallosal transchoroidal approach to a pineal teratoma in a 15-year-old boy. The OITA approach would allow excellent control of the lower half of the tumor, but the upper half would remain hidden behind the splenium and the vein of Galen. This lesion was highly located in the posterior third ventricle, so an interhemispheric transcallosal approach followed by a complete dissection of the whole choroidal fissure would allow complete exposure of the tumor mass to the line of sight of the operating microscope.

Results

Conclusion