{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:20Z","timestamp":1792176440282,"version":"4.4.0"},"reference-count":5,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,9,7]],"date-time":"2020-09-07T00:00:00Z","timestamp":1599436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    An endoscopic \u201ckeyhole\u201d approach to a deep-lying skull base lesion can be a daunting challenge. For the pineal region, the techniques for endoscopic resection of solid tumors in this location are also new.\n                    <jats:sup>1,2<\/jats:sup>\n                    In such a situation, surgical rehearsal in virtual reality (VR) can significantly improve the surgeon's confidence.\n                    <jats:sup>3<\/jats:sup>\n                    In this operative video, we demonstrate the use of VR in surgical planning and rehearsal to determine the best approach to a large, solid pineal tumor in a 46-yr-old patient. Using the patient's computed tomography angiography and magnetic resonance imaging, a VR model of his anatomy was created (SNAP VR360 version 3.8.0, Surgical Theater Inc, Cleveland, Ohio). VR rehearsal showed that, with the tumor tucked under the corpus callosum and cradled by the internal cerebral veins and veins of Rosenthal, a supratentorial approach would be suboptimal. Because of the steep angle of the patient's tentorium in the midline, a classic supracerebellar infratentorial (SCIT) approach would be challenging, and thus a paramedian variant of SCIT was chosen.\n                    <jats:sup>4<\/jats:sup>\n                    For a right-handed surgeon, the left side was used, and the endoscope was docked at the extreme left, out of the main surgical corridor. Shown in the video, the endoscopic resection achieved a complete resection. The histopathological diagnosis was a pineocytoma. No adjuvant treatment is recommended. Given the rarity of pineocytoma,\n                    <jats:sup>5<\/jats:sup>\n                    the novelty of endoscopic resection of solid tumors in the region, and the challenge of \u201ckeyhole\u201d approaches to deep-lying targets, VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure.\n                  <\/jats:p>\n                  <jats:p>Patient consent was obtained prior to the creation of the video and available on request.<\/jats:p>\n                  <jats:p>RHOTON images in the video are from The Rhoton Collection\u00ae.<\/jats:p>","DOI":"10.1093\/ons\/opaa270","type":"journal-article","created":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T01:03:59Z","timestamp":1599527039000},"page":"E51-E52","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Virtual Reality Surgical Rehearsal and 2-Dimensional Operative Video of a Paramedian Supracerebellar Infratentorial Approach Endoscopic Resection of Pineocytoma: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"20","author":[{"given":"Walter C","family":"Jean","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1]]},"reference":[{"key":"bib1-20260601","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1016\/j.wneu.2019.04.146","article-title":"The purely endoscopic supracerebellar infratentorial approach for resecting pineal region tumors with preservation of cerebellomesencephalic vein: technical note and preliminary clinical outcomes","volume":"128","author":"Gu","year":"2019","journal-title":"World Neurosurg"},{"key":"bib2-20260601","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2020.04.142","article-title":"Pure endoscopic supracerebellar infratentorial approach to the pineal region: a case series","author":"Shahrestani","year":"2020","journal-title":"World Neurosurg"},{"issue":"2","key":"bib3-20260601","doi-asserted-by":"crossref","first-page":"E179","DOI":"10.1093\/ons\/opaa017","article-title":"Expanded endoscopic endonasal transtuberculum approach for tuberculum sellae meningioma: operative video with 360-degree fly-through and surgical rehearsal in virtual reality","volume":"19","author":"Jean","year":"2020","journal-title":"Oper Neurosurg"},{"issue":"2","key":"bib4-20260601","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.wneu.2015.03.009","article-title":"Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of the four variant approaches","volume":"84","author":"Zaidi","year":"2015","journal-title":"World Neurosurg"},{"issue":"3","key":"bib5-20260601","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.nec.2011.05.004","article-title":"Contemporary management of pineocytoma","volume":"22","author":"Clark","year":"2011","journal-title":"Neurosurg Clin N Am"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/20\/1\/E51\/34879943\/opaa270.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:48:24Z","timestamp":1786121304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,7]]},"references-count":5,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opaa270","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,7]]},"assertion":[{"value":"2020-03-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}