Archives of Pediatric Neurosurgery (Dec 2019)

Infratentorial supracerebellar approach for microsurgical resection of large midline pineal region tumor: a technical note

  • Ricardo Santos de Oliveira,
  • Dinark Conceição Viana,
  • Matheus Fernando Manzolli Ballestero

DOI
https://doi.org/10.29327/apn.v1i1(September-December).11
Journal volume & issue
Vol. 1, no. 1(September-December)
pp. 29 – 31

Abstract

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Pineal region tumors pose certain challenges regarding to their resection: a deep surgical field, associated critical surrounding neurovascular structures, and narrow operative working corridor due to obstruction by the apex of the culmen. The authors describe a midline supracerebellar infratentorial approach that is routinely performed and was successfully used in the treatment of a large midline pineal region tumor in a 4 years old child. The surgeon achieved generous exposure of the caudal midline mesencephalon through a "cross-court" midline or oblique trajectory, while avoiding excessive retraction on the culmen demonstrating that large midline pineal region tumors can be removed through a suboccipital craniotomy. This approach is safe, may spare some of the midline vermian bridging veins, and may be potentially less invasive and more efficient than other surgical techniques.

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