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 VIDEO SECTION-OPERATIVE NUANCES: STEP BY STEP
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1557--1559

Gravity Assisted Retraction Less Occipito Transtentorial and Trans-Splenial Approach for Posterior Third Ventricular Dermoid


Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India

Correspondence Address:
Dr. Jayesh Sardhara
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333527

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Background and Introduction: A dermoid is an inclusion cyst. Its presence in the posterior third ventricle is highly infrequent. It usually compresses rather than infiltrates the posterior third ventricle's anatomical structures due to a well-defined capsule. Hence, the surgical anatomy in these tumors is less distorted. The approach to the posterior third ventricular tumors depends upon their relation to the galenic venous complex. Objective: This video abstract presents a case of the posterior third ventricular dermoid operated by gravity-assisted retraction less occipito transtentorial combined with the trans-splenial approach. Surgical Technique: A 36-year-old gentleman presented with a headache without any neurological deficits; the magnetic resonance imaging (MRI) revealed a well-defined heterogeneous lesion in the posterior third ventricular region. It was mainly toward the right side, just beneath the splenium, pushing the galenic venous system downward. This made the occipital transtentorial approach favorable as it required the least vessel handling. A right parieto-occipital craniotomy was performed. The patient was placed in a lateral semi-prone position with the head slightly rotated toward the right side with a slight neck extension. This allowed the right occipital lobe to fall away from the Falco-tentorial junction. With sharp dissection, an inter-Rosenthal corridor was made. But as the tumor was higher up in the posterior third ventricle, it was modified to another trans-splenial corridor. Near-total excision was achieved with a thin capsule left attached to the vein of Galen. The capsule was thick, filled with a cheesy white material, and a calcified sebaceous lump within. The postoperative scan showed no residual tumor. Results: The patient had improvement in the headache. There were no field cuts. The histopathology was suggestive of a dermoid cyst. Conclusions: Dermoid cysts of the posterior third ventricular region are rare, and judicious surgical decisions result in better outcomes.






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