Pineal Cyst: Drainage and Partial Capsule Resection

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Here is Drainage and Partial Resection of the Capsule for a Pineal Cyst. This is a 32 year old female presented with intractable headaches, photophobia, dizziness, as well as, nausea. MRI evaluation revealed a relatively sizable pineal cyst. There was no obvious evidence of hydrocephalus. Patient underwent, drainage of the cyst and partial resection of the capsule. I preferred to expose the midline pineal masses via a left or right sided supracerebellar craniotomy. I do not believe a midline craniotomy is necessary. Here's the exposure. Cerebellum was relatively full. The transverse sinus was unroofed. The cerebellum was gently retracted inferiorly. Tentorium was followed towards the midline. Leading from one of the torn region veins was controlled using thrombophob gel foam and gentle tamponade. Using a small cottonoid. A venous bleeding point in the tentorium was sealed. Dissection was continued. One has to be very careful not to get disoriented and continue dissection too far towards the contralateral tentorium. Here's the midline so here's going towards the contralateral tentorium. Here's the midline. So I redirected my dissection more anteriorly. The thick arachnoid meninx or the pineal region were sharply dissected. These arachnoid meninx can be quite tenacious and thick. Use of dynamic contraction is illustrated. An angled dissector was used to separate the arachnoid meninx and expose the posterior capsule of the cyst. Sharp dissection continues. You can see multiple layers of arachnoid that had to be dissected to reach the pineal cyst. As demonstrated here. More de-magnified view of the operative corridor. The cyst was interred and drained. You can see its contents. Next I tried to dissect and resect the part of the capsule that's not adherent to the surrounding structures, including the tectum. You saw a view of the a venal rosenthal. And were looking from right to left, across, across court. Part of the capsule that was dissectable is being removed. And looking at the dye cephalic veins on the left side. Can see a portion of the capsule that has been safely dissected off. Here's part of the tectum, that's very adherent to the anterior capsule. This part of the capsule was left behind. Here's looking far to the left where the tectum is adherent to the left side of the capsule. Here's the tectum adherent to the right side of the capsule. You can see only a small piece of capsule is left behind. There's the cephalon. The degree of adherence to the capsule is obvious. More de-magnified view of our operative corridor. And here's a post-operative CT scan demonstrating an equid decompression of the pineal cyst. Thank you.

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