case_images: PMC11228274_01
case_images: An axial CT scan of the head (A) reveals a right periatrial space occupying lesion. An axial T1-weighted MRI without contrast (B) demonstrates the exact location of the periatrial tumor. Enhanced images in sagittal, coronal, and transverse views of this patient brain MRI (C-E) demonstrated berry-like and irregular enhanced lesions in the right trigone of the lateral ventricle. Registration of the image-guided system (F-I) was performed. The patient position (J) in the contralateral PITTA. An axial postoperative CT scan (K) reveals a right atrial CPP that was resected via the left PITTA. An axial MRI T1-weighted sequence without contrast (L) excludes any unexpected injury to either posterior hemisphere. Postoperative axial T1-flair, T2-flair and T2-weighted without contrast images 4 years later (M-O) demonstrated complete resection via a contralateral approach.
case_images: fsurg-11-1371983-g001.jpg
case_images: PMC11228274_01_fsurg-11-1371983-g001.jpg
case_images: F1
case_images: Preoperative imaging demonstrated a right peritrigonal mass suspected to be a CPP (Figures 1A-E). Total resection of this histologically confirmed CPP was evident on Computed tomography (CT) of the head (Figure 1K) 1 day after surgery as well as no injury to the contralateral hemisphere. MRI of the head, performed without the administration of intravenous contrast material, was reportedly negative for any new findings at 4 years of follow-up (Figures 1M-O). Subsequent to positioning, the image-guided system is registered (Figures 1F-I). We employ a diminutive linear incision oriented perpendicular to the superior sagittal sinus, precisely situated over the occipital lobe (Figure 1J). T-shaped incision in the falx is performed as guided by neuronavigation to provide access to the precuneus over the lesion (Figure 1I). The horizontal component of the "T-shaped" incision is made in proximity to the inferior aspect of the superior sagittal sinus, while the vertical segment of the incision is prolonged until the inferior sagittal sinus undergoes coagulation and sectioning (Figures 1J,K). Subsequent to this exposure, the resection of the lesion can proceed through a cortical incision within the precuneus, allowing access to the periatrial region for the removal of the pathological tissue and the exposure of the choroid plexus in the atrium (Figure 1L).
case_images: Postoperative pathology: choroid plexus papilloma (WHO I). Immunohistochemical expressions: GFAP (+-), EMA (+), keratin (+++), CAM5.2 (+++), P53 (+), syn (++) and olig-2(-). Ki-67LI: 0.6% (A-H). Scale bar: (A,C-H) 100 mum, (B) 20 mum.
case_images: fsurg-11-1371983-g002.jpg
case_images: PMC11228274_01_fsurg-11-1371983-g002.jpg
case_images: F2
case_images: Ki-67LI was 0.6% (Figures 2A-H).
case_images: This patient underwent preoperative embolization (A-D). After cutting the occipital bone, the contralateral precuneus gyrus was located (E,F). The "T-shaped" incision in the falx has been completed and the tumor was completely resected (G,H). The endoscope (I-L) provided supplemental visualization of the temporal horn and the body of the lateral ventricle to check for any residual tumor and to remove the iatrogenic clot.
case_images: fsurg-11-1371983-g003.jpg
case_images: PMC11228274_01_fsurg-11-1371983-g003.jpg
case_images: F3
case_images: The right PchA were identified prior to embolization (Figures 3A-D).
case_images: Illustrations and intraoperative photographs of the procedure. (A) Patient position and various incision options for approaching a left periatrial lesion while placing the contralateral "approach" hemisphere in the more dependent position to use gravity retraction. (B) Bur holes are placed on the superior sagittal sinus and a parasagittal craniotomy is completed while exposing the corresponding segment of the dural sinus. (C) A dural opening is made while avoiding the important bridging veins in the region. (D) The "T-shaped" incision within the falx cerebri to expose the contralateral medial hemisphere. (E) Placement of additional sutures on the falcine dural flaps to increase the transfalcine working angle and corridor to the contralateral atrium.
case_images: fsurg-11-1371983-g004.jpg
case_images: PMC11228274_01_fsurg-11-1371983-g004.jpg
case_images: F4
case_images: The (Figures 4A-E) is the Illustrations and intraoperative photographs of the procedure.