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INTRODUCTION
Brainstem low-grade gliomas in locations
other than tectal midbrain often require more definitive therapy. With the
advent of the MRI and advances in operative techniques, neurosurgical resection
is attempted for many non-tectal brainstem low-grade gliomas. This video
demonstrates the surgical technique used for the suprafacial approach to a
progressive focal pontine pilocytic astrocytoma. The patient consented to
publication of her images. The patient was a 17 year old female who had
presented to outside center with a known history of neurofibromatosis type 1
but neurological difficulties secondary to a cystic and solid lesion of the
brainstem. VP shunt was placement first and then a biopsy was performed and an
Ommaya reservoir placed in the cyst. Unfortunately, the cyst would refill on a
weekly basis at which point the patient would have difficulty walking and
swallowing as well as trouble with speech. This necessitated weekly tapping of
the reservoir. Then the patient was transferred to our hospital. The patient
was put in prone position. We used telovelar approach to expose all the way up
to the aqueduct. Under the guidance of stimulation and mapping of the floor of
4th ventricle, we chose the suprafacial collicular safe entry zone to resect
the tumor. The tumor was pretty vascular and we got a gross total resection
which was confirmed by the intraoperative MRI. The pathology was pilocytic
astrocytoma. Postoperatively, the patient’s body movement was normal and right
facial weakness remained at her baseline and resolved at 3 months follow-up.
DISCLOSURE
The authors have no personal, financial or
institutional interest in any of the drugs, materials or devices described in
this article.
DISCLOSURE OF
FUNDING
None.
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