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 NI SPECIAL FEATURE: OPERATIVE NUANCES: STEP BY STEP (VIDEO SECTION)
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1307--1309

Supracerebellar Infratentorial Endoscopy for Quadrigeminal Cistern Epidermoid


Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Correspondence Address:
Dr. Sivashanmugam Dhandapani
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304077

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Background: The standard microscopic supracerebellar infratentorial approach for the pineal region is limited by tunnel vision. Herein, we describe endoscopic supracerebellar infratentorial surgery in a patient with quadrigeminal cistern epidermoid presenting with hydrocephalus. Description: In the sitting position, following a 6 cm longitudinal incision and small suboccipital craniotomy, the dura was cut in V shape and kept reflected. The bridging veins were coagulated and cut, taking the 0° endoscope inside. A sharp incision is given over the thickened arachnoid over the inferior paramedian area. The precentral cerebellar vein is exposed at the lower part, coagulated and divided. Gentle bimanual intracapsular removal of the epidermoid flakes is performed with intermittent saline irrigation and suction. Assisted by rotating the angled endoscope, curved coaxial instruments help remove the cerebello-mesencephalic and lateral extensions of the epidermoid. Conclusion: Endoscopic supracerebellar infratentorial approach provides a panoramic and angled view of the pineal region, through a narrow corridor, avoiding cerebellar retraction.






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