Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report.
OBJECTIVE
Accepted surgical strategies to address symptomatic pineal cysts include transventricular flexible or rigid endoscopy and supracerebellar infratentorial or occipital transtentorial microsurgical approaches. We report the first application of the endoscopic supracerebellar infratentorial approach for the complete resection of a pineal cyst. Unlike transventricular endoscopy, this technique poses no risk to the fornices and can be applied independent of ventricular size.


METHODS
A 37-year-old woman sought treatment for intractable headaches. A thorough evaluation revealed only a pineal cyst exerting mass effect on the tectum but causing no hydrocephalus. A period of nonoperative management was unsuccessful, and the patient was referred for surgery.


METHODS
The patient was positioned in the semi-sitting position. The supracerebellar infratentorial corridor was accessed through a burr-hole. The pineal cyst was resected completely via the endoscope. Postoperatively, the patient's headaches resolved completely.


CONCLUSIONS
The endoscopic supracerebellar infratentorial approach involves minimal brain retraction, poses no risk to the fornices, allows visualization and avoidance of the Galenic veins, and can be performed regardless of the size of the ventricle. Consequently, it is an excellent minimally invasive surgical option for resection or fenestration of symptomatic pineal cysts.
Gore
Pankaj A
PA
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Gonzalez
L Fernando
LF
Rekate
Harold L
HL
Nakaji
Peter
P
D000328:Adult; D002531:Cerebellum / Q000473:pathology* / Q000601:surgery*; D003560:Cysts / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D044583:Neuroendoscopy / Q000379:methods*; D010870:Pineal Gland / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome