Endoscope-controlled Supra-cerebellar Infra-tentorial Approach for Excision Of A Pineal Region Cystic Mass

653 653 Samer Elbabaa

Endoscope-controlled Supra-cerebellar Infra-tentorial Approach for Excision Of A Pineal Region Cystic Mass

Diagnosis: Pineal region cyst
  • 14-year old girl
  • Chronic headaches followed conservatively for 3 years for a stable pineal cystic mass
  • She presented with acute progression of her symptoms
  • New MRI showed a slight increase in the size of the mass as well as new proteinous content of the cyst on T2-MRI images
  • Different approaches were considered including the classic microsurgical supra-cerebellar infratentorial approach, the parieto-occipital transtentorial approach or posterior transcallosal approach
  • Decision was made in favor of an endoscope controlled supra-cerebellar infra-tentorial approach to the pineal region via a small suboccipital craniotomy
  • Complete non-eventful excision of the pineal cystic mass was achieved via an endoscope controlled supra-cerebellar infra-tentorial approach
  • Symptoms resolved completely
EQUIPMENT USED
  • Aesculap skull base endoscopes 0° and 30° lenses
  • Neuro-navigation
SURGICAL TIPS
  • Semi-sitting position, TEE reduces the risk of air embolism. This allows sagging of the cerebellum with no need for retractors
Pre op
Post op
Operative position
Author

Samer Elbabaa

All cases by: Samer Elbabaa