Posterior interhemispheric retrocallosal approach to pineal region and posterior fossa lesions in a pediatric population

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  • Division of Neurosurgery, Children's Hospital Los Angeles, and Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Object

The purpose of this study was to evaluate the posterior interhemispheric retrocallosal approach (PIRA) for its safety and efficacy in the resection of pineal region and posterior fossa lesions in children.

Methods

Twenty-nine PIRAs were performed in 26 children between March 1997 and March 2009, and these cases were retrospectively reviewed. There were 15 girls and 11 boys in the series. The median age at the time of surgery was 7 years (range 7 months–17 years). Twenty-seven cases were treated for tumor, 1 for loculated hydrocephalus, and 1 for an aneurysm.

Results

Of the 27 cases treated for tumor, there were 20 (74%) gross-total resections, 5 (19%) subtotal resections, and 2 (7%) biopsies. One bridging vein was sacrificed in 6 cases and 2 bridging veins were divided in 1 case, whereas in 3 cases there was sacrifice of a single deep cerebral vein. No patient developed radiographic evidence of venous infarction. Approach-related complications were low, and included 2 cases of transient homonymous hemianopia. There were no surgery-related deaths.

Conclusions

This approach allows for ample access to pineal region and posterior fossa lesions, with low postoperative morbidity.

Abbreviation used in this paper: PIRA = posterior interhemispheric retrocallosal approach.

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Contributor Notes

Address correspondence to: Laurence Davidson, M.D., 1300 North Vermont Avenue, Suite 1006, Los Angeles, California 90027. email: ldavidso@usc.edu.
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