March 04, 2014
Let's go ahead and review the operative events for a section of a parasagittal glioma. This is a 42 year-old male who presented with a single seizure. MRI revealed a relatively fade area of T2 and flair hyperintensity in the right parasagittal frontal lobe. This area did not demonstrate any evidence of enhancement. A low grade glioma was suspected and resection was undertaken. A right-sided parasagittal craniotomy was completed. Here's the location of the superior sagittal sinus. The patient's headings in the neutral supine position, neuro navigation was used to identify the exact borders of the tumor. Bipolar forceps were used to coagulate the pial over the borders of the tumor. This video again demonstrates the basic principles of glioma resection. Next, the coagulated pial surfaces were transected. Tumor often feels more rubbery, slightly discolored from the surrounding pre tumoral areas. I use a higher intensity for the bipolars and then use the bipolar forceps like scissors to disconnect and emulsify the tumor borders. Here's the medial frontal pial surfaces next to the falx. These pial surfaces are also coagulated and cut. Tumor is being disconnected efficiently. Again using the bipolar forceps to disconnect the border of the tumor while the suction device evacuates the part of the tumor that is emulsified by the bipolar forceps. The margins of resection cavity appear relatively clean, white glistening surface of the normal white matter, or I should say relatively normal white matter. Here's the medial pial surfaces that are being coagulated and the tumor is being disconnected at this area as well. The resection cavity is further inspected and I remove another layer of thin pre tumoral areas to assure aggressive tumor removal in this area, since this is a relatively non-functional part of the brain and more aggressive resection strategy is relatively safe. That's a final view of our cavity, all the vessels were carefully protected, specially the emphasized ones. No navigation further confirms adequate removal of the tumor and the post-operative MRI in this case demonstrated reasonable removal of the mass without any complicating features, thank you.
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