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Case report
peer-reviewed

Resection of a Pediatric Thalamic Juvenile Pilocytic Astrocytoma with Whole Brain Tractography



Abstract

The resection of deep-seated brain tumors has been associated with morbidity due to injury to critical neural structures during the approach. Recent technological advancements in navigation and stereotaxy, surgical planning, brain tractography and minimal-access brain ports present the opportunity to overcome such limitations. Here, we present the case of a pediatric patient with a left thalamic/midbrain juvenile pilocytic astrocytoma (JPA). The tumor displaced the corticospinal fibers posteriorly and resulted in hemiparesis. Using whole brain tractography to plan a corridor for the approach, neuronavigation, a tubular retractor and an exoscope for visualization, we obtained gross total resection of the tumor, while minimizing injury to white matter bundles, including the corticospinal fibers. We propose that surgical planning with whole brain tractography is essential for reducing morbidity while accessing deep-lying brain lesions via retractor tubes, by means of sparing critical fiber tracts.



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Case report
peer-reviewed

Resection of a Pediatric Thalamic Juvenile Pilocytic Astrocytoma with Whole Brain Tractography


Author Information

Howard L. Weiner

Division of Pediatric Neurosurgery, Department of Surgery, Texas Children’s Hospital

Dimitris G. Placantonakis Corresponding Author

Neurosurgery, NYU School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dimitris G. Placantonakis declare(s) personal fees from Synaptive Medical. Dr. Placantonakis received consulting fees from Synaptive Medical in the past. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Resection of a Pediatric Thalamic Juvenile Pilocytic Astrocytoma with Whole Brain Tractography


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Case report
peer-reviewed

Resection of a Pediatric Thalamic Juvenile Pilocytic Astrocytoma with Whole Brain Tractography

Howard L. Weiner">Howard L. Weiner, Dimitris G. Placantonakis">Dimitris G. Placantonakis

  • Author Information
    Howard L. Weiner

    Division of Pediatric Neurosurgery, Department of Surgery, Texas Children’s Hospital

    Dimitris G. Placantonakis Corresponding Author

    Neurosurgery, NYU School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dimitris G. Placantonakis declare(s) personal fees from Synaptive Medical. Dr. Placantonakis received consulting fees from Synaptive Medical in the past. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: October 11, 2017

    DOI

    10.7759/cureus.1768

    Cite this article as:

    Weiner H L, Placantonakis D G (October 11, 2017) Resection of a Pediatric Thalamic Juvenile Pilocytic Astrocytoma with Whole Brain Tractography. Cureus 9(10): e1768. doi:10.7759/cureus.1768

    Publication history

    Received by Cureus: August 02, 2017
    Peer review began: August 17, 2017
    Peer review concluded: September 21, 2017
    Published: October 11, 2017

    Copyright

    © Copyright 2017
    Weiner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The resection of deep-seated brain tumors has been associated with morbidity due to injury to critical neural structures during the approach. Recent technological advancements in navigation and stereotaxy, surgical planning, brain tractography and minimal-access brain ports present the opportunity to overcome such limitations. Here, we present the case of a pediatric patient with a left thalamic/midbrain juvenile pilocytic astrocytoma (JPA). The tumor displaced the corticospinal fibers posteriorly and resulted in hemiparesis. Using whole brain tractography to plan a corridor for the approach, neuronavigation, a tubular retractor and an exoscope for visualization, we obtained gross total resection of the tumor, while minimizing injury to white matter bundles, including the corticospinal fibers. We propose that surgical planning with whole brain tractography is essential for reducing morbidity while accessing deep-lying brain lesions via retractor tubes, by means of sparing critical fiber tracts.



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Create a free account to continue reading this article.

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Howard L. Weiner

Division of Pediatric Neurosurgery, Department of Surgery, Texas Children’s Hospital

Dimitris G. Placantonakis

Neurosurgery, NYU School of Medicine

For correspondence:
dimitris.placantonakis@nyumc.org

Howard L. Weiner

Division of Pediatric Neurosurgery, Department of Surgery, Texas Children’s Hospital

Dimitris G. Placantonakis

Neurosurgery, NYU School of Medicine

For correspondence:
dimitris.placantonakis@nyumc.org