Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Opening of the Third Ventricle

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This video shows the third ventricle being opened and aqueduct identified.

Keywords

  • Third ventricle
  • Mammillary bodies
  • Basilar artery
  • Tuber cinereum

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_20
Online ISBN
978-3-030-16006-7
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

Then the third ventricle is opened, and the opening of the third ventricle finally allows the identification of the most anterior boundary of the tumor. We recognize the very small remnant of tumor that [? delimitates ?] the surgical cavity from the third ventricle. And here is the progressive [? delimitation ?] of the cavity of the third ventricle. Here we are opening it.

And on the image on the top left, we see the access where we are working at this time. We remove progressively the membrane that is [? delimitating ?] the surgical cavity from the third ventricle. And we can finally explore the most anterior part of the ventricular system, the third ventricle, where we should be able to recognize the massa intermedia and hopefully, the floor of the third ventricle.

It is very clear at this time the anatomy of the floor of the third ventricle with the mammillary bodies. And we decide, also, because of the triventricular obstructive nature of the hydrocephalus and the [INAUDIBLE] [? presents ?] of the ventricular peritoneal shunt to perform an microsurgical third ventriculostomy in order to remove the ventricular peritoneal shunt and leave the patient without any ventricular-peritoneal-shunting system.

At this point, the inlet of the aqueduct is well visible in the posterior part of the third ventricle. We continue the cleaning of the surgical cavity by coagulating the surface of the posterior aspect of the thalamus in order to obtain the best possible [? anastomosis. ?] And this is clear the plane of attachment of the tumor on the thalamus.

And we are proceeding to cleaning– the best possible cleaning– of the cavity. We give an overall look to the surgical cavity. And then finally, we proceed to explore the anterior part of the third ventricle, performing the third ventriculostomy.