{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:01:00Z","timestamp":1786125660635,"version":"build-2736575974"},"reference-count":3,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"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"],"abstract":"Abstract<\/jats:title>\n \n Pineal region tumors remain challenging lesions to safely resect because of their central location.\n 1<\/jats:sup>\n Patients frequently present with symptoms associated with hydrocephalus and brainstem compression.\n 2<\/jats:sup>\n Local anatomy, primarily the tentorium angle and venous anatomy, plays a central role in the selection of the approach.\n 3<\/jats:sup>\n The paramedian supracerebellar approach pioneered by Ya\u015fargil in 1984\n 4<\/jats:sup>\n allows to access the pineal region through a less steep angle while avoiding the central thickened arachnoid and midline cerebellar and vermian veins.\n 3<\/jats:sup>\n <\/jats:p>\n \n Although the author strongly prefers the advantageous three-quarter concord position, this early case was performed in a sitting position, which requires a bubble test to rule out the presence of a persistent foramen ovale. The preoperative pineal differential diagnosis should be exhaustive, including blood and cerebrospinal fluid (CSF) tumor markers in suitable cases. Hemangioblastomas are seldom found or expected in the pineal area, and the surgeon must be alarmed by their typical \u201ccherry nodule\u201d appearance.\n 2<\/jats:sup>\n ,<\/jats:sup>\n 5<\/jats:sup>\n Their recognition prior to resection is paramount in avoiding excessive blood loss from tumor entry. Similar to arteriovenous malformations, hemangioblastoma surgical tenets include\n en bloc<\/jats:italic>\n resection and preservation of the main draining veins until the last steps of the resection. Von Hippel-Lindau (VHL) syndrome genetic workup is necessary is similar patients, as more than 25% of hemangioblastomas are associated with VHL tumor suppressor gene mutations in chromosome 3.\n 2<\/jats:sup>\n The patient consented to the surgery and use of her photography.\n <\/jats:p>\n \n Image at 2:41 from Ueyama et al, Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations,\n Neurosurgery<\/jats:italic>\n , 1998, 43(5),\n 3<\/jats:sup>\n used with permission from the Congress of Neurological Surgeons.\n <\/jats:p>","DOI":"10.1093\/ons\/opab104","type":"journal-article","created":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:36:10Z","timestamp":1619829370000},"page":"E34-E35","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Pineal Region Hemangioblastoma Resection Through Paramedian Supracerebellar Approach: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-0563","authenticated-orcid":false,"given":"Walid I B N","family":"Essayed","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emad","family":"Aboud","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,7]]},"reference":[{"issue":"1","key":"bib2-20251027","first-page":"55","article-title":"Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease","volume":"48","author":"Conway","year":"2001","journal-title":"Neurosurgery"},{"issue":"5","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1097\/00006123-199811000-00068","article-title":"Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations","volume":"43","author":"Ueyama","year":"1998","journal-title":"Neurosurgery"},{"issue":"2","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"E423","DOI":"10.1227\/01.NEU.0000255516.12085.BB","article-title":"A hemangioblastoma in the pineal region","volume":"61","author":"Isolan","year":"2007","journal-title":"Neurosurgery"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/1\/E34\/38595304\/opab104.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab104","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:59:55Z","timestamp":1786121995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,30]]},"references-count":3,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab104","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,30]]},"assertion":[{"value":"2021-01-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}