Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Dissection of the Interhemispheric Fissure: Reopening of surgical cavity, dissection and debulking of the tumor

Your browser needs to be JavaScript capable to view this video

Try reloading this page, or reviewing your browser settings

This video segment shows progressive removal of the residual tumor from the lateral ventricles.

Keywords

  • Interhemispheric fissure
  • Cerebral falx
  • Cyngulate gyri
  • Pericallosal artery
  • Callosomarginal artery
  • Pericallosal cistern
  • Corpus callosum
  • Tumor dissection and debulking
  • lateral ventricle
  • choroid plexus

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_18
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

So it was decided to reopen the surgical cavity– dissect and debulk the remnant of the tumor. Three weeks later, the reopening of the interhemispheric fissure is certainly easier if compared to the first time. The singular gyri are, again, identified and dissected together with the callosomarginal and pericallosal arteries. The previous callosotomy is identified, and self-retaining retractor are advanced in the surgical field in order to identify the septum pellucidum.

And the tumor is finally identified. The tumor is certainly much less vascular if compared to the previous two surgeries. It has been significantly reduced in size, as well as the vascularization.

And finally the line of demarcation compared to the normal tissue is much easier to identify and follow with the bipolar forceps. It is very nicely demarcated. Some venous minor– venous sacrifice is necessary in order to allow a complete resection of the remnant of the tumor. And the dissection of a larger vein as possible at this time.

And as you can see, the line of dissection is easy to find at this point. And with the simple maneuver with the bipolar coagulator, the plan of dissection is followed in a very simple way at this point. The bleeding is much easier to control, and that the remnant of the tumor certainly is much smaller issue compared to the previous two surgeries.

The line of delimitation between the tumor and the normal tissue is easily identified also posteriorly. And the tumor is easily coagulated and dissected from the neural tissue in order to remove it if possibly, unblock. Here, the ependyma is removed and easily separated by the tumor.

In some areas, the demarcation of the tumor is more difficult to find, especially on the more peripheral areas of the tumor. But the very significant removal at this time can be achieved almost attaining a complete removal, at this time, of the intraventricular part.

The bipolar coagulation allows progressive separation of the tumor from the normal tissue with easy identification of the boundaries of the tumor. Section and the sharp resection can be applied as well when the vision is perfectly under control.

Bipolar coagulation remains very efficient if we want to separate the tumor and remove the tumor en bloc instead of decompressing. In this case, internal decompression was not necessary because the tumor remnants were not so big, and the bleeding was certainly much less important if compared to the previous surgeries.

Venous efferents are finally coagualted and cut, and the big tumor remnant can be removed easily, as you can see, in an almost bloodless surgical field because of the excellent devascularization of the tumor obtained in the previous two surgeries.