Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Internal Debulking of the Tumor

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This video shows progressive debulking of the tumor.


  • Tumor debulking
  • Ultrasonic surgical aspirator

About this video

Giuseppe Cinalli
Matteo Sacco
First online
16 March 2019
Online ISBN
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

We can see how heterogenous is the tumor mass and sometimes how difficult can be to find the dissection plane. For this reason, we have to progressively reduce the internal parts of the tumor from tumor fragment. And internal debulking of the tumor must be continued with the ultrasonic aspirator because at this point, the tumor remains quite vascularized. But it is a vascularization that can be dominated with the bipolar coagulator quite effectively. And in spite of the very young age of the patient, this bleeding will allow us to achieve a very good internal decompression of the tumor.

The irregular shape of the tumor makes difficult to identify at every point the limits between the tumor and neural tissue. This is the tedious part of the surgery because internal decompression requires frequently adoption of coagulation of scissors in order to remove piecemeal parts of the tumor and to perform a sharp dissection on some areas where the internal decompression risks to be dangerous with the ultrasonic aspirator.

So this part of the surgery can be certainly slow and boring and difficult, but you can see that with patience, we can identify the plane of dissection. And after progressive identification of the plane of dissection, we continue with our work of internal decompression, internal removal of the tumor, being careful of keeping identified the position, the anatomical position of the internal cerebral vein in order to avoid venous injury with our activity of internal decompression with the ultrasonic aspirator.

This tool is really extremely effective in internal decompression of the tumor. You see that we use it with the lowest effective surgical power In order to avoid excessive bleeding from the tumor tissue and to limit, as much as possible, the risk of neural injury in these delicate areas.

You see how tedious is this work of volumetric [INAUDIBLE] reduction of the tumor that is, nevertheless, very important and absolutely necessary before starting to dissect the capsule from the normal tissue around. Without this work, the dissection is much more complicated because of the residual tumor mass that can create a visual obstacle to the further dissection.

At this point of the procedure, we realize that we have not good control on the left side of the tumor. That remains very much bloody because of the still excellent, good supply. We continue the debulking, but it is clear that the right interim is very– the right side of the folds is not sufficient to achieve a good control on the left side. For this reason, after continuing the dissection until the farthest possible place, we decide to approach the tumor from the left tumorspheric fissure.