Retractorless interforniceal approach for microsurgical resection of a papillary tumor of the pineal region: operative video and technical nuances.

James K Liu,Neil Majmundar

doi:10.3171/2021.4.focvid2139

Abstract

In this illustrative video, the authors demonstrate microsurgical resection of a papillary tumor of the pineal region using a retractorless interforniceal approach via the anterior interhemispheric transcallosal route. The tumor presented to the posterior third ventricle occluding the cerebral aqueduct, resulting in obstructive hydrocephalus. The retractorless interforniceal approach is performed in the lateral position with BICOL collagen spacers to keep the corridor open. Gross-total resection was achieved, and the patient was neurologically intact without needing a permanent shunt. The operative nuances and pearls of technique for safe microdissection and gentle handling of the retractorless interforniceal approach are demonstrated.The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2139.

Highlights

In this illustrative video, the authors demonstrate microsurgical resection of a papillary tumor of the pineal region using a retractorless interforniceal approach via the anterior interhemispheric transcallosal route
CT scan showed a solid pineal region mass occupying the posterior third ventricle resulting in obstructive hydrocephalus
The final pathology was a papillary tumor of the pineal region

Summary

Introduction

The authors demonstrate microsurgical resection of a papillary tumor of the pineal region using a retractorless interforniceal approach via the anterior interhemispheric transcallosal route. This is Dr James Liu, and I will be demonstrating the retractorless interforniceal approach via the anterior interhemispheric transcallosal route for microsurgical resection of a papillary tumor of the pineal region. CT scan showed a solid pineal region mass occupying the posterior third ventricle resulting in obstructive hydrocephalus. MRI scan demonstrated an enhancing pineal region mass that was hyperintense on T1 and T2/FLAIR images with some enhancement after gadolinium. The final pathology was a papillary tumor of the pineal region.

Results

Conclusion