Abstract
BackgroundPineal region tumours remain challenging neurosurgical pathologies.MethodsDetailed anatomical knowledge of the posterior incisural space and its variations is critical. An opaque arachnoidal membrane seals the internal cerebral and basal veins, leading to thalamic, basal ganglia, mesencephalic/pontine infarctions if injured. Medium-size tumours can be removed en-bloc with all traction/manipulation applied on the tumour side, virtually without contact of ependymal surfaces of the pulvinars or third ventricle. Sacrifice of the cerebello-mesencephalic fissure vein may be required.ConclusionsThe sitting position offers superior anatomical orientation and remains safe with experienced teams. Meticulous microsurgical techniques and detailed anatomical knowledge are likely to secure safe outcomes.
Highlights
Pineal region tumours remain challenging neurosurgical pathologies
Off midline approaches are available for pineal region tumours, the midline IT/SC approach offers optimal surgical orientation in the region of posterior incisura, bounded superiorly by the inferior aspect of the splenium, the forniceal crura and the hippocampal
The internal cerebral veins (ICv) lie deeper, laterally and slightly underneath the basal veins of Rosenthal (BvRo) exiting through the cistern of the velum interpositum, converging to the vein of Galen (VG) [4]
Summary
Pineal region tumours remain challenging neurosurgical pathologies. The complex pineal region can be accessed by the supracerebellar/infratentorial (SC/IT) approach, occipital transtentorial, posterior interhemispheric transcallosal and the combined supra-/IT approach, for giant tumours. Off midline (lateral and far-lateral) approaches are available for pineal region tumours, the midline IT/SC approach offers optimal surgical orientation in the region of posterior incisura, bounded superiorly by the inferior aspect of the splenium, the forniceal crura and the hippocampal
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