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Case Reports
. 2018 Jul;34(7):1397-1399.
doi: 10.1007/s00381-018-3797-7. Epub 2018 Apr 23.

Extended endoscopic supracerebellar infratentorial (EESI) approach for a complex pineal region tumour-a technical note

Saurabh Sinha  1 , Elizabeth Culpin  2 , John McMullan  2
Affiliations
Case Reports

Extended endoscopic supracerebellar infratentorial (EESI) approach for a complex pineal region tumour-a technical note

Saurabh Sinha et al. Childs Nerv Syst. 2018 Jul.

Abstract

Endoscopic-assisted approaches have been shown to be a suitable alternative to the standard microscopic approach to pineal region tumours. With extension laterally into the ventricles, the 0° endoscope and microscope have significant limitations. We describe the extended endoscopic supracerebellar infratentorial (EESI) approach using angled endoscopes for a complex pineal region tumour that extended into the lateral ventricle. A 15-year-old boy presented with headaches and ataxia. MRI revealed a pineal region tumour extending into the lateral ventricle. The patient was positioned in the sitting position. The supracerebellar infratentorial corridor was accessed through a small craniotomy. The tumour was resected completely via the endoscope. Postoperatively, the patient's symptoms resolved completely. We believe that this case highlights the benefit of using the endoscopic extended supracerebellar infratentorial (EESI) approach to resect pineal region lesions that extend beyond the midline.

Keywords: Extended endoscopic supracerebellar infratentorial approach; MRI; Parinaud syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Preoperative images showing a tumour in the pineal region extending into the left lateral ventricle, compressing the tectum and causing caudal displacement of the cerebellum
Fig. 2
Fig. 2
Endoscopic views of the approach and tumour. a Initial view with a 0° endoscope showing the tentorium superiorly, the cerebellum covered with a cottonoid inferiorly and the pineal recess anteriorly. b Initial view of midline aspect of tumour (cerebellum, tent and tumour labelled). c Closeup view of tumour with cottonoid covering cerebellum inferiorly. d 30° endoscope view of tumour within left lateral ventricle. e 30° endoscope view of left lateral ventricle after tumour excised
Fig. 3
Fig. 3
Postoperative MRI images showing complete resection of tumour at the end of procedure
See this image and copyright information in PMC

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