Name:
10.3171/2023.10.FOCVID23106
Description:
10.3171/2023.10.FOCVID23106
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/15938a00-90d4-4893-af89-14a405360237/videoscrubberimages/Scrubber_129.jpg
Duration:
T00H05M44S
Embed URL:
https://stream.cadmore.media/player/15938a00-90d4-4893-af89-14a405360237
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/15938a00-90d4-4893-af89-14a405360237/14. 23-106.mp4?sv=2019-02-02&sr=c&sig=KNK6pMW9vSFMilVG4Kxp6sseHqWiAE9O0UGxHEfkSuM%3D&st=2025-02-05T04%3A33%3A12Z&se=2025-02-05T06%3A38%3A12Z&sp=r
Upload Date:
2023-12-06T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: This video case report demonstrates an exoscopic removal of the fourth ventricle choroid plexus papilloma with the use of a midline suboccipital osteoplastic craniotomy. An 18-year-old boy presented with 2-year-long moderate tension headache and 1-year-long trauma with gradual deterioration. Neurological examination revealed the presence of intention tremor, otherwise without features. Preoperative MRI demonstrated a cauliflower-like tumor completely occupying the fourth ventricle with intensive and homogeneous contrast enhancement.
SPEAKER: The first line of treatment for all choroid plexus tumors is maximal surgical resection. In this case, the patient was placed in Concorde position. The use of an exoscope in lesions of the fourth ventricle is associated with better visualization. A flat angle of view allows direct access to the tumor of the fourth ventricle practically through the foramen of Magendie, enlarged because of the tumor, which allows minimizing the size of the craniotomy and damage to the surrounding tissue.
SPEAKER: Due to the compact design and mobility of the exoscope, the surgeon can change the viewing angle in a wide range without changing the position of the body and with less arm strain. Midline suboccipital osteoplastic craniotomy, also named as cobra craniotomy, is a variant of craniotomy where the atlanto-occipital membrane is preserved. In the existing studies, it is presented as an alternative method potentially reducing the risk of postoperative complications.
SPEAKER: A small straight incision was performed with dissection of the muscles along the midline. The occipital bone and C1 were skeletonized with preserving the atlanto-occipital membrane.
SPEAKER: One burr hole craniotomy was made followed by dissection of the atlanto-occipital membrane from the dura. Intraoperative ultrasound showed hyperechogenic tumor in the fourth ventricle. The dura was opened with a C-shaped incision.
SPEAKER: The first view revealed the choroid plexus tumor highly adhered to the surrounding structures. The tumor was dissected and devascularized stepwise. In this case of a vascular tumor, Thulium:YAG laser was used for inner decompression. Then the tumor was collected for pathology study.
SPEAKER: The use of the Thulium: YAG laser contributed to minimizing the bleeding from the tumor surface during its removal. The exoscope was helpful to easily visualize the roof of the fourth ventricle and remove the remnants of the tumor.
SPEAKER: The arachnoid membrane and the dura were closed in an ordinary fashion. Early postoperative MRI proved gross-total resection of the tumor. Pathology analysis revealed choroid plexus papilloma grade I. Postoperative CT reconstruction showed the craniotomy sized 3.6 by 2.6 cm.
SPEAKER: In the postoperative period, the patient did not have any CSF leak, additional neurological disorders, or any other complications. The exoscope proved to be a useful instrument that facilitated visualization of the lesion of any part of the fourth ventricle, even the aqueduct and the ventricular roof, which allowed minimizing the size of dissection and performing the access to the tumor via minimal possible approach.
SPEAKER: It also ensured a comfortable positioning of the surgeon during all steps of the procedure. The use of midline suboccipital osteoplastic craniotomy reduced potential risks of complications, in particular, CSF leak and vertebral junction instability. These advantages contributed to minimal damage to the surrounding tissues, high precision of manipulations, and consequently, a successful outcome for the patient.
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