Springer Nature medical video. Interhemispheric transtentorial approach to a teratoma of the pineal region / produced by Springer Nature.

9783030954963

Dordrecht, South Holland : Springer Nature, 2022.

1 online resource (51 minutes)

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The video describes the posterior interhemispheric transtentorial approach to a teratoma of the pineal region. A 7-year old boy was admitted for gait disorder and visual impairment associated with Parinaud's syndrome. MRI showed a solid-microcystic lesion of pineal region associated with triventricular hydrocephalus. Third-ventriculostomy and tumor biopsy were performed. Hystology was inconclusive but CSF ß-HCG was mildly elevated. Chemotherapy following GCT protocol was performed but tumor progressed at two months. Direct surgical approach via interhemispheric transtentorial route was therefore decided with the aim of maximum safe removal. The tumor was located in the pineal region, bulging inside the posterior part of the third ventricle. Its presence determined a significant downward compression of the tectal plate and of the upper vermis, and upward stretching of both internal cerebral veins. MRI showed an heterogeneous texture with areas of contrast enhancement alternated with cystic areas. Due to the pineal origin and downward displacement of the tectal plate, telovelar approach was not considered. Due to the very low position of the lower pole, the supracerebellar approach was discarded as well. Interhemispheric transcallosal transchoroidal approach was considered as an excellent possibility but interhemispheric transtentorial approach was preferred because it allows to reach the tumor without callosal incision and without the need of extended choroidal dissection. MRI showed total removal of the tumor, that histology confirmed as teratoma. The patient did not develop any post-operative motor or memory deficit. MRI shows no residual tumor or regrowth at two-year follow up. The child follows his normal school activity without any external support and with excellent results.

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February 27, 2023