Multistage Surgical Resection of a Giant Pineal Tumor in an Infant

Tumor Debulking

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This video segment shows the dissection of the lower pole of the tumor, tumor debulking process, and dissection of the quadrigeminal cistern.


  • Vermis
  • Tentorium
  • Tumor
  • Cerebellum
  • Quadrigeminal cistern
  • Internal decompression
  • Ultrasonic surgical aspirator
  • Aspiration
  • Fragmentation

About this video

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

Video Transcript

The tumor debulking is, of course, very important in order to create some space of maneuver and facilitate the dissection of the most peripheral part of the tumor that is the [INAUDIBLE] neural tissue and the basal vein. Here you can see the inferior, the lower pole of the tumor that can be dissected free from the cerebellum thanks to the layer of the arachnoid of the quadrigeminal cistern. This dissection is possible thanks to the debulking that has been performed previously, and is very clear the plan of separation between the lower pole and the cerebellum.

After identifying this fold of the section we’ll continue with the internal dissection that is key to the father removal of the tumor. Internal decompression is really very careful under control of the bipolar coagulation because the bleeding is very significant both from the tumor and also from around the tumor at every minimal attempt of global mobilization without a careful dissection.

At this age, of course, we have to be extremely careful about sparing the blood, because the least bleeding we have during surgery, the longest can be the surgical removal and the largest can be the tissue, the tumoral tissue that is removed.

After father debulking of the tumor, we continue the dissection of the inferior ball of the tumor that is surrounded by veins that, of course, facilitate bleeding. And we have to coagulate every single small vein around the tumor. Then, we continue the internal debulking of the tumor to the tentorial opening. And as you see, the removal on very large part of this tumor is performed with the sucker and with a very tight and narrow control of the bipolar coagulation in order to limit the bleeding as much as possible.