Laparoscope-Assisted Guidance to the Pineal Region

Tumors arising in the pineal region present a number of challenges when planning for effective removal. This report describes the successful resection of a falcotentorial meningioma occurring in a 56-year-old female using a supracerebellar infratentorial approach. In order to excise the pineal region mass, a unique combination of instrumentation was used, including a microscope, endoscope, and abdominal laparoscope. This technique afforded us passage to the pineal region, which allowed for enhanced visualization and maneuverability and was more amenable to decreasing the physical stress of the operating surgeon. This article is the first to detail the use of an abdominal laparoscope to remove a pineal tumor of this size for near-total resection. The various surgical approaches and tools traditionally used to remove pineal tumors are discussed, and the particular advantages and disadvantages of our hybrid approach are reviewed.