August 05, 2014
Here's another video for resection of a parieto-occipital GBM, in this case, a very large one. This is a 42 year-old male who presented with subtle left-sided weakness. MRI evaluation revealed a medial posterior parietal lesion, partly hemorrhagic, somewhat heterogeneously, enhancing consistent with anaplastic astrocytoma. Patient underwent a resection of this mass in the lateral position, and right-sided parasagittal, posterior parietal craniotomy was completed. Here's the location of the superior sagittal sinus, neuronavigation was used to map the borders of the tumor as marked by the black suture, peel surfaces were coagulated. The margins of the tumor were disconnected, and bipolar forceps were used like scissors to disconnect the tumor from the pre-tumoral white matter areas. Again, these are the standard techniques for removal of intra-axial gliomas. You can see how the bipolar forceps at a relatively high temperature are used as scissors to disconnect the white matter tracks. Obviously, the discolored areas of the tumor that appeared to be of a higher grade are generously removed and are more easy to differentiate from the surrounding normal or relatively normal brain. Neuronavigation continuously guided the extent of resection. Here's the apex of the tumor, the bulk of the tumor was removed, and importantly, the bed of the resection cavity, was carefully inspected and cleaned out until relatively normal or yellow glistening white matter was encountered. So pure removal of the tumor within the peel of the interhemispheric fissure was conducted. Hemostasis was secured, before the closure was completed. Here's the final result of the operative corridor and the post-operative MRI demonstrated reasonable resection of the tumor. Thank you.
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