Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections

World Neurosurg. 2018 Sep:117:195-198. doi: 10.1016/j.wneu.2018.06.080. Epub 2018 Jun 20.

Abstract

Objective: In recent decades endoscopic techniques have been increasingly used in neurosurgery as they may offer a valuable close-up view of the working area through a minimally invasive surgical corridor. Herein, we present an inexpensive and efficient endoscopic surgical model using a borescope, which was used for a "modified pure endoscopic approach" to the pineal region.

Methods: A borescope video camera was connected to a 16-inch personal computer monitor. A standard midline suboccipital craniotomy was performed on 2 cadaveric heads in the Concorde position. Then, a "borescopic" supracerebellar infratentorial approach was executed, thus reaching the pineal region, which was exposed through an extensive arachnoid dissection.

Results: Using the previously described model, we were able to provide excellent exposure of the main neurovascular structures of the pineal region, as shown by the intraoperative videos. In 1 specimen we identified an incidental pineal cyst that was meticulously dissected and removed.

Conclusions: Our proposed "borescopic" surgical model may represent an inexpensive and efficient alternative to conventional endoscopic techniques and could be used for training purposes, as well as even for clinical procedures, after a proper validation, particularly in economically challenging environments.

Keywords: Borescope; Endoscope; Neuroendoscopy; Pineal region; Supracerebellar infratentorial approach; Surgical training.

Publication types

  • Video-Audio Media

MeSH terms

  • Computers / economics
  • Craniotomy
  • Dissection
  • Humans
  • Incidental Findings
  • Neuroendoscopy / economics
  • Neuroendoscopy / education*
  • Neuroendoscopy / instrumentation*
  • Pineal Gland / blood supply
  • Pineal Gland / diagnostic imaging
  • Pineal Gland / surgery*
  • Pinealoma / diagnostic imaging
  • Pinealoma / surgery
  • Proof of Concept Study
  • Video Recording / economics
  • Video Recording / instrumentation