Abstract
Described by Dandy in 1921, the posterior interhemispheric transcallosal approach provides an operative corridor to the pineal region, posterior third ventricle, and upper midbrain. Intervenous-interforniceal and paravenous-interforniceal variants have been utilized for midline and paramidline pathology, respectively. The intervenous-interforniceal variant capitalizes on the natural separation of the internal cerebral veins, which are found medial to the forniceal crura at this level, to provide a safe corridor to the tumor while minimizing the risk of injury to the fornices. Here, the authors describe a posterior interhemispheric transcallosal approach using the intervenous-interforniceal variant for resection of a periaqueductal pilocytic astrocytoma.The video can be found here: https://youtu.be/mtQKEXEveTg.
Highlights
We describe a posterior, interhemispheric, transcallosal intervenous-interforniceal approach to a periaqueductal tegmental tumor
1:22 Preop imaging 2 Coronal views demonstrated that the posterior commissure was draped over the mass, and sagittal views indicated that the tectum was displaced posteriorly by the lesion
2:34 Relevant anatomy A key feature of the posterior transcallosal intervenousinterforniceal approach is the anatomical relationship of the internal cerebral veins and forniceal crura
Summary
We describe a posterior, interhemispheric, transcallosal intervenous-interforniceal approach to a periaqueductal tegmental tumor. Imaging revealed obstructive hydrocephalus secondary to a mass centered in the periaqueductal region of the tegmentum. Mild tumoral edema was visualized extending along the posterior and medial margins of the mass, with mass effect resulting in obstruction of the cerebral aqueduct. 1:22 Preop imaging 2 Coronal views demonstrated that the posterior commissure was draped over the mass, and sagittal views indicated that the tectum was displaced posteriorly by the lesion.
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