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Francesco Certo, Giada Toccaceli, Roberto Altieri and Giuseppe M. V. Barbagallo

Transcript We present a case of thalamomesencephalic cavernoma removed by anterior transcallosal transchoroidal approach. The patient is a 62-year-old man who presented, after mild brain injury, acute onset of diplopia, headache, and vomiting. Because of persistence of symptoms, he performed a brain CT that showed a right thalamomesencephalic bleeding, with a maximum diameter of 12 mm. For these reasons, patient was admitted in Neurosurgery Department and performed an MRI scan that showed a right periaqueductal gray mesencephalic and thalamic cavernoma and the

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David S. Hersh, Katherine N. Sanford and Frederick A. Boop

Transcript In this video, we describe a posterior, interhemispheric, transcallosal intervenous-interforniceal approach to a periaqueductal tegmental tumor. 0:33 History The patient was a 15-year-old female who presented with headaches. Imaging revealed obstructive hydrocephalus secondary to a mass centered in the periaqueductal region of the tegmentum. 0:57 Preop imaging 1 T1- and T2-weighted MRI sequences demonstrated a T2 hyperintense mass centered along the periaqueductal region, measuring approximately 1.3 cm in all three planes. There was nodular rim

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Alireza Shoakazemi, Alexander I. Evins, Justin C. Burrell, Philip E. Stieg and Antonio Bernardo

et al. in 1988 for the excision of deep intraparenchymal lesions. 20 Since then, tubular retractor design and application have been greatly improved and a number of different types of these systems have been introduced. The endoscopic transcortical, interhemispheric transcallosal, and microsurgical transcortical approaches are commonly used routes to access lesions of the third ventricle. In specific cases, depending on the anatomy of the lesion and other clinical factors, the transcallosal approach may provide an optimal surgical corridor to the third ventricle

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William T. Couldwell

Symptomatic brain stem cavernous malformations often present the dilemma of choosing an approach for their resection. Superior midline midbrain lesions are in a particularly challenging location, as they are less accessible via traditional lateral or posterior approaches. The author presents a case of a young woman who presented with a symptomatic cavernous malformation with surface presentation to the floor of the third ventricle. The lesion was causing sensory symptoms from local mass effect and hydrocephalus from occlusion of the Aqueduct of Sylvius. An approach was chosen to both perform a third ventriculostomy and remove the cavernous malformation. Through a right frontal craniotomy, a transcallosal–transforaminal approach was used to perform a third ventriculostomy. Through the same callosal opening, a subchoroidal approach was performed to provide access the cavernous malformation. The details of the procedure and nuances of technique are described in the narration.

The video can be found here: http://youtu.be/zKKnehp7l2c.

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Daniel G. Nehls, Stephen R. Marano and Robert F. Spetzler

T he transcallosal technique has recently enjoyed wide popularity for approaching lesions in the region of the third ventricle. Since its description by Dandy 1 in 1922, it has been shown to be safe and effective for dealing with various lesions. 3–7 The transcallosal approach has also been used with success for lesions within or adjacent to the lateral ventricle. 3, 5, 6 We recently had the opportunity to use this technique to treat an arteriovenous malformation (AVM) arising from the floor of the left lateral ventricle. We elected to use a crossed

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João Luiz Vitorino Araujo, José C. E. Veiga, Hung Tzu Wen, Almir F. de Andrade, Manoel J. Teixeira, José P. Otoch, Albert L. Rhoton Jr., Mark C. Preul, Robert F. Spetzler and Eberval G. Figueiredo

the third ventricle. 17 , 20 , 35 , 38 , 39 The transcallosal-transchoroidal approach to the third ventricle allows for adequate exposure of the middle and posterior regions of the ventricle. However, the fornix column limits exposure of the anterior region of the third ventricle. 30 , 38 There is evidence that a unilateral lesion of the fornix column has little or no impact on memory. 2 , 4 , 8 , 15 , 22 , 25 , 28 , 30 , 43 Various regions and structures participate in the memory circuit, and the fornix is just one of these structures. Changes to other parts of

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João Luiz Vitorino Araujo, José C. E. Veiga, Hung Tzu Wen, Almir F. de Andrade, Manoel J. Teixeira, José P. Otoch, Albert L. Rhoton Jr., Mark C. Preul, Robert F. Spetzler and Eberval G. Figueiredo

accessing the third ventricle. 17 , 20 , 35 , 38 , 39 The transcallosal-transchoroidal approach to the third ventricle allows for adequate exposure of the middle and posterior regions of the ventricle. However, the fornix column limits exposure of the anterior region of the third ventricle. 30 , 38 There is evidence that a unilateral lesion of the fornix column has little or no impact on memory. 2 , 4 , 8 , 15 , 22 , 25 , 28 , 30 , 43 Various regions and structures participate in the memory circuit, and the fornix is just one of these structures. Changes to other parts

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Sean A. McNatt, Ivan J. Sosa, Mark D. Krieger and J. Gordon McComb

T he interhemispheric transcallosal approach provides an excellent surgical corridor to deep-seated midline brain lesions. Because there is considerable potential morbidity associated with any resection in this region, it is important to identify technical maneuvers that can safely optimize visualization and access. Concern exists regarding the safety of sacrificing middle-third SSS cortical bridging veins to attain and improve the surgical exposure. Methods A retrospective review was conducted of cases involving patients who underwent an

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Don M. Long and Shelley N. Chou

sign of increased intracranial pressure. The location of the neoplasm was apparent on the air study, which appears to be the best way to localize the mass definitively. Operative Technique In two of the patients a standard subfrontal approach was used first, to try to remove the tumor. In one of these patients the approach was extended to become subtemporal to expose a portion of the tumor anterior to the brain stem. Recurrence of the tumor in each case in the intraventricular position required reoperation via the transcallosal approach. Two of the adults

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Wenqing Jia, Zhenyu Ma, Isabelle Yisha Liu, Yuqi Zhang, Ge Jia and Weiqing Wan

T he pineal region is located in the central area of the brain. It is near several important brain structures such as the midbrain, thalamus, vein of Galen, internal cerebral vein, and quadrigeminal bodies. Pineal region tumors are encountered with an incidence of 0.6%–0.9% in North America and Europe, 3.0%–3.2% in Japan and Southeast Asia, and 3% in China. 1 , 21 , 32 Pineal region tumors are difficult to completely resect, and postoperative complications are not uncommon. There are 4 possible surgical approaches to the pineal region: transcallosal