PMC4392546_01
Gadolinium (Gd)-enhanced magnetic resonance (MR) images. In the preoperative images, the tumor was homogeneously enhanced by Gd, which extended to the dorsal part in the third ventricle (a and b). The MR images obtained 5 days after the operation. The tumor was totally removed with mild enhancement of the ventricular wall reflecting postoperative changes (c and d)
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F1
Brain magnetic resonance imaging (MRI) revealed a large, well-enhanced mass in the third ventricle that was adherent to the pituitary stalk and enlarged lateral ventricles [Figure 1a and b]. Postoperative MRI revealed total tumor removal without ventricular wall injury [Figure 1c and d] and a normal pituitary gland.
Intraoperative images and photographs. (a): Schematic sketch of the combined surgical approach with a videoscope for the third ventricular craniopharyngioma. (b): Microscopic view of the tumor removal. The tumor (T) was dissected by a dissector (arrow heads) with the assistance of forceps through the contralateral videoscope (arrow). (c-e) Videoscopic view of the tumor removal through the contralateral ventricle. The tumor was pushed by the forceps (arrow) through the videoscope (c). The interface between the tumor and the left wall of the third ventricle was well observed (white arrowheads) (d). The tumor was almost removed. The anterior wall of the third ventricle (asterisk) was observed through the videoscope (e)
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F2
A craniotomy was made in the right frontal region over the coronal suture, and one burr hole was made in the left frontal bone [Figure 2a]. The right lateral ventricle was opened, and the enlarged foramen of Monro with a yellowish tumor was observed [Figure 2a]. By pressing the tumor with forceps [Figure 2b and c], the tumor was debulked easily. Thus, tumor dissection from the ventricular wall was conducted safely with videoscope visualization [Figure 2d and e] without fornix retraction.