Dissection of the Tumor and Reopening of Previous Surgical Cavity
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This video shows a dissection of the interhemispheric fissure, opening of adhesions of previous surgery, dissection of pericallosal arteries and of cingulate gyri.
- Interhemispheric fissure
- Cerebral falx
- Cyngulate gyri
- Pericallosal artery
- Callosomarginal artery
- Pericallosal cistern
- Corpus callosum
About this video
- Giuseppe Cinalli
- Matteo Sacco
- First online
- 16 March 2019
- Online ISBN
- Springer, Cham
- Copyright information
- © The Author(s) 2019
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.