| Summary: | The video describes the surgical strategy for approaching a large mass located in the posterior half of the third ventricle occluding the sylvian aqueduct and causing significant obstructive triventricular hydrocephalus in a 10-year old girl. Hydrocephalus was treated first with an endoscopic third ventriculostomy, and an attempt to biopsy the tumor failed due to hemorrhage from the lesion. It was therefore decided to approach the tumor directly with the aim of the maximum possible safe removal. The three main surgical options are presented: The transcallosal/transforaminal route, the posterior interhemispheric/transtentorial route and the anterior interhemispheric transcallosal/transchoroidal route. The respective advantages and disadvantages of the three approaches are discussed and the reasons for ultimately selecting the transcallosal/transchoroidal route are explained. The rationale for choosing this approach comes from a careful analysis of pre-operative MRI scans on high definition sagittal images, which show how the tumor is located at the entrance of the sylvian aqueduct, whose inlet is extremely dilated, assuming a wide funnel shape. A post-operative MRI shows near total removal of the tumor, which the histology confirmed as pilocytic astrocytoma.
|
|---|