Sitting position for pineal surgery: Some anaesthetic considerations

Dallier, F.; Roio, C. Di

doi:10.1016/j.neuchi.2014.10.110

Cited by 23 publications

(25 citation statements)

References 14 publications

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“…The most common complications include diplopia or upward gaze (Parinaud's syndrome) due to additional irritation of the quadrigeminal plate or postoperative pneumocephalus, if surgery was performed in the sitting position. 6 Our case series demonstrates that, although postoperative symptoms were present, most were transient and did not result in longterm morbidity. Nevertheless, surgical removal of tectal lesions should be reserved for centers that have established sufficient neurosurgical expertise.…”

Section: Discussionmentioning

confidence: 62%

Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Mohme¹,

Fritzsche²,

Mende³

et al. 2018

Neurosurgical Focus

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OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

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Section: Discussionmentioning

confidence: 62%

Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Mohme¹,

Fritzsche²,

Mende³

et al. 2018

Neurosurgical Focus

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“…Akan tetapi banyak komplikasi dari posisi duduk yang harus menjadi pertimbangan, antara lain hemodinamika yang tidak stabil akibat venous pooling di ekstremitas bawah, penurunan perfusi otak akibat efek gravitasi, pneumocephalus, hematoma subdural, kuadriplegia, makroglosia, kerusakan saraf akibat penekanan di pleksus brakialis dan sciatica, dan venous air embolism (VAE). 3,4 Venous air embolism terjadi karena masuknya udara ke sistem vaskular, dapat terjadi kapanpun ketika terdapat hubungan antara lingkungan dan vena yang terbuka pada tekanan subatmosfer. Deteksi dini VAE penting untuk dilakukan karena VAE dapat mengobstruksi sirkulasi pulmoner yang menyebabkan gagal jantung kanan dan henti jantung.…”

Section: Pendahuluanunclassified

“…3 Prinsip airway, breathing, circulation, drugs, environment (ABCDE) neuroanestesi, posisi duduk dan segala komplikasinya, lokasi operasi yang sulit adalah beberapa pertimbangan anestesi yang harus diperhatikan pada pasien ini. 4 Koordinasi dan komunikasi yang baik antara dokter bedah saraf dan anestesi dalam melakukan kraniotomi dengan posisi duduk harus dilakukan untuk dapat mengantisipasi kemungkinan komplikasi yang terjadi.…”

Section: Pendahuluanunclassified

Manajemen Anestesi pada Pasien dengan Tumor Regio Pineal yang Menjalani Kraniotomi Pengangkatan Tumor dengan Posisi Duduk

Widiastuti¹,

Bisri²,

Harahap³

et al. 2021

JNI

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Incidence of pineal regio tumor is 0.4-1% of intracranial tumors. Its location which is buried between two cerebral hemispheres, close to brainstem and hypothalamus become a difficult challenge for the neurosurgeon. Surgery with supracerebellar approach in sitting position is the best method to access the lesion. Sitting position also facilitates the optimal visual field with minimal retractions. However, for anesthesiologist, sitting position is challenging since it has its own complexities during positioning the patient and the risk of complications. Venous air embolism is one of the main concern and if not detected early and treated appropriately would leads to cardiovascular collapse instantly. This is a case of a 38-year-old male with chief complaint of severe headache and blurred vision started 4 months before admission. The Magnetic Resonance Imaging showed a pineal region tumor with perifocal edema, without midline deviation. The patient underwent craniotomy tumor removal with sitting position. The procedure lasted for 10 hours and uneventful. The principle of ABCDE neuroanesthesia, sitting position and its implications, and difficult tumor location are some anesthesia considerations for this patient. A thorough preoperative evaluation, good communication and coordination between surgery and anesthesia team are needed for a smooth uneventful procedure performed in sitting position.

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“…The endoscope reduced the need for retraction of the occipital lobe and provided a better and wider view of the posterior, inferior, and medial surfaces of the pulvinar than the microscope. There is a risk of air embolism in this approach 11 if the sitting position is selected, and of morbidity related to sacrifice of bridging veins draining into the tentorial sinuses and galenic complex. 47 …”

Section: Posterior Interhemispheric Transtentorial Approachmentioning

confidence: 99%

Microsurgical and endoscopic approaches to the pulvinar

Akiyama

Matsushima

Güngör

et al. 2017

Journal of Neurosurgery

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OBJECTIVEApproaches to the pulvinar remain challenging because of the depth of the target, surrounding critical neural structures, and complicated arterial and venous relationships. The purpose of this study was to compare the surgical approaches to different parts of the pulvinar and to examine the efficacy of the endoscope as an adjunct to the operating microscope in this area.METHODSThe pulvinar was examined in 6 formalin-fixed human cadaveric heads through 5 approaches: 4 above and 1 below the tentorium. Each approach was performed using both the surgical microscope and 0° or 45° rigid endoscopes.RESULTSThe pulvinar has a lateral ventricular and a medial cisternal surface that are separated by the fornix and the choroidal fissure, which wrap around the posterior surface of the pulvinar. The medial cisternal part of the pulvinar can be further divided into upper and lower parts. The superior parietal lobule approach is suitable for lesions in the upper ventricular and cisternal parts. Interhemispheric precuneus and posterior transcallosal approaches are suitable for lesions in the part of the pulvinar forming the anterior wall of the atrium and adjacent cisternal part. The posterior interhemispheric transtentorial approach is suitable for lesions in the lower cisternal part and the supracerebellar infratentorial approach is suitable for lesions in the inferior and medial cisternal parts.The microscope provided satisfactory views of the ventricular and cisternal surfaces of the pulvinar and adjacent neural and vascular structures. The endoscope provided multi-angled and wider views of the pulvinar and adjacent structures.CONCLUSIONSA combination of endoscopic and microsurgical techniques allows optimal exposure of the pulvinar.

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Sitting position for pineal surgery: Some anaesthetic considerations

Cited by 23 publications

References 14 publications

Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Manajemen Anestesi pada Pasien dengan Tumor Regio Pineal yang Menjalani Kraniotomi Pengangkatan Tumor dengan Posisi Duduk

Microsurgical and endoscopic approaches to the pulvinar

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