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Cranio-Orbital Pretemporal Approach for Microsurgical Resection of Hypothalamic Rosette Forming Glioneuronal Tumor
Nebojsa Lasica1, Talal Siddiq2, Richard Hessler3
1Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Abstract:
The hypothalamic region is susceptible to involvement of several processes.1 Lesions in this region remain challenging for surgical access and treatment. Strategies include both endoscopic and microsurgical approaches.2 A cranio-orbital approach with extradural clinoidectomy and optic canal unroofing provides the necessary corridor to visualize and decompress the optic nerve/chiasm and remains an important tool in achieving complete tumor resection with favorable functional and visual outcomes.3-12 Endoscope assistance in transcranial surgery is well established, used to provide direct visualization of hidden adjacent tissues.13 A 25-year-old woman presented with headache and progressive visual loss to blindness (hand waving and light perception) on admission. Magnetic resonance imaging demonstrated a 28-mm-diameter tumor in the hypothalamic region with no significant postcontrast enhancement. She underwent right cranio-orbital craniotomy, extradural anterior clinoidectomy, and optic canal unroofing with a 2-mm high-speed diamond drill and copious irrigation. After ipsilateral falciform ligament release, the tumor capsule was coagulated, sharply opened, and resected in a piecemeal fashion. Endoscopic assistance warranted the removal of hidden parts and confirmed tumor removal. Histopathology and next-generation sequencing confirmed the diagnosis of rosette-forming glioneural tumor. Follow-up revealed gross total tumor removal on magnetic resonance imaging and complete recovery of visual function as per ophthalmologist examination. Rosette-forming glioneural tumors are considered rare and classified as World Health Organization grade I tumors usually found in the fourth ventricle.14 To our knowledge, we present the first operative video (Video 1) demonstrating the removal of rosette-forming glioneural tumor in the hypothalamic region with endoscopic assistance.
Insights
This study details the successful surgical removal of a rare hypothalamic rosette-forming glioneural tumor using a cranio-orbital approach with endoscopic assistance. The minimally invasive technique led to complete tumor resection and full visual recovery.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Minimally Invasive Surgery
Background:
- The hypothalamic region presents surgical challenges due to its complex anatomy.
- Endoscopic and microsurgical techniques are employed for hypothalamic lesion treatment.
- A cranio-orbital approach facilitates access for optic nerve decompression and tumor resection.
Observation:
- A 25-year-old female presented with visual loss and headache.
- MRI revealed a 28mm hypothalamic tumor.
- The patient underwent a right cranio-orbital craniotomy with extradural anterior clinoidectomy and optic canal unroofing.
Findings:
- Endoscopic assistance enabled visualization and resection of hidden tumor portions.
- Histopathology confirmed a World Health Organization grade I rosette-forming glioneural tumor.
- Gross total tumor removal was achieved with complete visual function recovery.
Implications:
- This case highlights the efficacy of endoscopic-assisted cranio-orbital surgery for rare hypothalamic tumors.
- The described technique offers a viable corridor for complex tumor removal with favorable outcomes.
- This approach may improve functional and visual recovery in patients with hypothalamic region tumors.
