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Atrial Metastatic Tumors: Transcortical Approach

December 09, 2015


This procedure illustrates resection of anterior atrial metastatic tumors and more specifically a uterine adenocarcinoma via transcortical transparietal approach around the area of the superior parietal lobule. This patient is a 50 year old female who presented with left visual dysfunction and visual field loss with a history of uterine cancer. This mass proved eventually to be an adenocarcinoma with a primary from the uterine cancer. The tumor is relatively cystic, it's located along the posterior aspect of the thalamus and anterior lateral wall of the atrium or the trigone. A transfalcine approach is most likely not appropriate due to the very inferior location of the mass. The interhemispheric approach similarly is not a good fit because the tumor is somewhat located anteriorly along the deep veins. Therefore, a transparietal approach seemed to make more sense; here's the patient positioning on the operating table. The lateral position was chosen, the head is turned toward the floor, inner skull clamp and a paramedian linear incision as guided by neuro-navigation was undertaken. Following completion of incision a craniotomy was performed, a small cortical incision, again as guided by neuro-navigation was conducted. Here's the area of our corticotomy on navigation and the initial deep white matter dissection was extended toward the capsule of the tumor and the cyst was drained and the soft capsule was removed. Corticotomy was further extended as the tumor capsule was exposed; here is the soft tumor capsule. You can see some of the CSF draining from the temporal horn. Here's the temporal horn walls. Here's the location of the tumor as further resection is completed. This is the walls of the resection cavity that appear to be clean. The extended final corticotomy was demonstrated a moment ago; here is the post-operative MRI, which describes gross total resection of the mass without any complicating features. Thank you.

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