Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Dissection of the Interhemispheric Fissure and Re-opening of Previous Callosotomy

Your browser needs to be JavaScript capable to view this video

Try reloading this page, or reviewing your browser settings

This video shows a dissection of the interhemispheric fissure, opening of adhesions of previous surgery, dissection of pericallosal arteries and of cingulate gyri.

Keywords

  • Interhemispheric fissure
  • Cerebral falx
  • Cyngulate gyri
  • Pericallosal artery
  • Callosomarginal artery
  • Pericallosal cistern
  • Corpus callosum

About this video

Author(s)
Giuseppe Cinalli
Matteo Sacco
First online
16 March 2019
DOI
https://doi.org/10.1007/978-3-030-16006-7_13
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

Here we see the dissection of the interhemispheric fissure and reopening of previous callosotomy. We found the adhesions created by the previous surgery performed in another country through a posterior transcallosal approach. We identified tissue that is probably a remnant of a fibrin glue that has been placed in the interhemispheric fissure.

And we are obliged to a very long and delicate work of dissection of these adhesions at the level of the interhemispheric fissure, avoiding neural damages to the cingulate gyri. And carefully identify the vascular structures that are present at the level of the interhemispheric fissures, the callosal marginal arteries, the pericallosal arteries. And that this is made difficult, of course, by the presence of the dense adhesions induced by the previous surgery.

The dissection can be smooth or sharp. Rhoton dissector are very important. We identify quickly the previous callosotomy after identification of the right callosal marginal artery and of the cingulate gyrus.

The pericallosal cistern is difficult to identify, but fortunately, the pericallosal artery are very well visible and cannot be dissected. Here, we identify also the left singular gyrus, the right pericallosal artery, the right singular gyrus, and the right callosal marginal arteries.

The Rhoton dissector is very important. It’s very useful in progressing posteriorly with the dissection of the adhesion. We can see the pericallosal artery that can be densely there and to the cingulate gyrus of the other side. And sometimes, the dissection has to be sharp in order to avoid [? tractions ?] on the pericallosal arteries. It is also very adherent to the contralateral pericallosal artery.

We have to dissect the two vessels very, very careful in order to avoid excessive manipulation and limit the possibility of post-operative spasm. After a very careful dissection, we finally identify the plan of the section that is best in order to lead us to the previous surgery.