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

Clinical article

Restricted access

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.
Article Information

Contributor Notes

Address correspondence to: Laurence Davidson, M.D., 1300 North Vermont Avenue, Suite 1006, Los Angeles, California 90027. email: ldavidso@usc.edu.
Headings
References
  • 1

    Andrews RJBringas JR: A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 33:105210641993

    • Search Google Scholar
    • Export Citation
  • 2

    Ausman JIMalik GMDujovny MMann R: Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 29:2983061988

  • 3

    Bedford THB: The great vein of Galen and the syndrome of increased intracranial pressure. Brain 57:1241934

  • 4

    Bedford THB: The venous system of the velum interpositum of the rhesus monkey and the effect of experimental occlusion of the great vein of Galen. Brain 57:2552651934

    • Search Google Scholar
    • Export Citation
  • 5

    Chi JHLawton MT: Posterior interhemispheric approach: surgical technique, application to vascular lesions, and benefits of gravity retraction. Neurosurgery 59:1 Suppl 1ONS41ONS492006

    • Search Google Scholar
    • Export Citation
  • 6

    Dandy WE: Extirpation of the pineal body. J Exp Med 22:2372461915

  • 7

    Dandy WE: An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:1131191921

  • 8

    Giordano MWrede KHStieglitz LHColumbano LSamii MLuedemann WO: Depiction of small veins draining into the vein of galen using preoperative 3-dimensional navigation in living patients. Neurosurgery 64:5 Suppl 22472522009

    • Search Google Scholar
    • Export Citation
  • 9

    Glasauer FE: An operative approach to pineal tumors. Acta Neurochir (Wien) 22:1771801970

  • 10

    Hammock MKMilhorat THEarle KDi Chiro G: Vein of Galen ligation in the primate. Angiographic, gross, and light microscopic evaluation. J Neurosurg 34:77831971

    • Search Google Scholar
    • Export Citation
  • 11

    Krause F: Operative Freilegung der Vierhügel, nebst Beobachtungen über Hirndruck und Dekompression. Zentralbl Chir 53:281228191926

    • Search Google Scholar
    • Export Citation
  • 12

    Kunicki A: Operative experiences in 8 cases of pineal tumor. J Neurosurg 17:8158231960

  • 13

    Kurokawa YUede THashi K: Operative approach to mediosuperior cerebellar tumors: occipital interhemispheric transtentorial approach. Surg Neurol 51:4214251999

    • Search Google Scholar
    • Export Citation
  • 14

    McComb JGApuzzo MLJThe lateral decubitus position for the surgical approach to pineal location tumors. Marlin AE: Concepts in Pediatric Neurosurgery BaselS. Karger1988. 8:186199

    • Search Google Scholar
    • Export Citation
  • 15

    McComb JGLevy MLApuzzo MLJThe posterior intrahemispheric retrocallosal and transcallosal approaches to the third ventricle region. Apuzzo MLJ: Surgery of the Third Ventricle ed 2BaltimoreWilliams & Wilkins1998. 743778

    • Search Google Scholar
    • Export Citation
  • 16

    Nazzaro JMShults WTNeuwelt EA: Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76:7467511992

    • Search Google Scholar
    • Export Citation
  • 17

    Poppen JL: The right occipital approach to a pinealoma. J Neurosurg 25:7067101966

  • 18

    Rorschach H: Zur Pathologie und operabilität der Tumoren der Zirbeldrüse. Beitr Klin Chir 83:4514741913

  • 19

    Shirane RShamoto HUmezawa KSu CCKumabe TJokura H: Surgical treatment of pineal region tumours through the occipital transtentorial approach: evaluation of the effectiveness of intra-operative micro-endoscopy combined with neuronavigation. Acta Neurochir (Wien) 141:8018091999

    • Search Google Scholar
    • Export Citation
  • 20

    Smith RRSanford RADisorders and the deep cerebral veins. Kapp JPSchmidek HH: The Cerebral Venous System and Its Disorders New YorkGrune & Stratton1984. 547555

    • Search Google Scholar
    • Export Citation
  • 21

    Stern WEBatzdorf URich JR: Challenges of surgical excision of tumors in the pineal region. Bull Los Angeles Neurol Soc 36:1051181971

    • Search Google Scholar
    • Export Citation
  • 22

    Suzuki JIwabuchi T: Surgical removal of pineal tumors (pinealomas and teratomas). Experience in a series of 19 cases. J Neurosurg 23:5655711965

    • Search Google Scholar
    • Export Citation
  • 23

    Van Wagenen WPA: A surgical approach for the removal of certain pineal tumors: Report of a case. Surg Gynecol Obstet 53:2162201931

  • 24

    Xu WMellergård PUngerstedt UNordström CH: Local changes in cerebral energy metabolism due to brain retraction during routine neurosurgical procedures. Acta Neurochir (Wien) 144:6796832002

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 232 128 12
Full Text Views 73 22 1
PDF Downloads 162 27 1
EPUB Downloads 0 0 0
PubMed
Google Scholar