# Craniopharyngioma — GCMD Library living collection

Everything in the library about craniopharyngioma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 67 cited statements

## Episodes
### Surgical Management
- [Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380) — video · 21:33 · [machine version](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380.md)
- [Endoscopic Assist for Pediatric Tumors, Vascular, and Hydrocephalus:...](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383) — video · 20:32 · [machine version](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383.md)
- [Minimally Disruptive Subcortical Neurosurgery in Children - Concepts of the...](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387) — video · 21:32 · [machine version](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=0) Introduction and Framework: Pediatric Perspective on Endoscopic Skull Base Surgery (Ep 1)
- [7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420) Continuum of Minimally Invasive Approaches and Pathology Categorization (Ep 1)
- [11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700) Transclival Transodontoid Approach for Craniocervical Junction Abnormalities (Ep 1)
- [16:25](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=985) Q&A: Positioning, Staging, Equipment, and Practical Considerations (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=0) Introduction of Dr. Jerry Grant (Ep 2)
- [0:33](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=33) Endoscopic-Assist vs. Endoscopic-Controlled Techniques and Safety Principles (Ep 2)
- [7:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=420) Transnasal and Combined Approaches for Sellar/Suprasellar Lesions (Ep 2)
- [10:40](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=640) Endoscopic Assist for Craniopharyngiomas and Skull Base Tumors (Ep 2)
- [15:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=900) Transciliary Approaches and Minimally Invasive Corridors (Ep 2)
- [17:30](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1050) Endoscopic Assist for Shunt Revisions (Ep 2)
- [18:08](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1088) Technical Pearls: Scope Heat, Moisture, and Safety (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=0) Introduction and framing of minimally disruptive subcortical approaches (Ep 3)
- [1:25](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=85) Pediatric brain tumor characteristics and surgical goals (Ep 3)
- [4:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=280) Subcortical injury and parafascicular trajectory principles (Ep 3)
- [7:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=420) BrainPath system features and capabilities (Ep 3)
- [9:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=540) Comparison of traditional craniotomy, endoscopic, and BrainPath approaches (Ep 3)
- [10:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=640) Case examples: hemorrhagic caudate mass and posterior deep lesion (Ep 3)
- [13:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=780) Craniopharyngioma and choroid plexus papilloma cases (Ep 3)
- [15:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=900) Rolandic cavernoma cases and series outcomes (Ep 3)
- [16:49](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1009) Technical discussion: instruments and endoscope integration (Ep 3)
- [19:22](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1162) Trans-sulcal technique and vascular safety (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal." — Greenfield (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=0)
- "Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy." — Greenfield (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case." — Greenfield (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges." — Greenfield (clinical) [Ep 1 · 16:25](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=985)
- "The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases." — Greenfield (clinical) [Ep 1 · 18:29](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- "There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces." — Greenfield (clinical) [Ep 1 · 18:29](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- "Endonasal equipment and scopes are designed to work in very small spaces and work well in the pediatric nose; while it is a little tighter, it is not so tight that cases cannot be done, and the practice has never had to avoid using an instrument because the nose was too small." — Schwartz (clinical) [Ep 1 · 19:30](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1170)
- "Application-specific equipment and scope technology for endoscopic neurosurgery has evolved to meet demands, with the armamentarium for skull base work being distinctly different from that used for intraventricular work." (host_summary) [Ep 1 · 20:01](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1201)
- "Endoscopic-assist uses the endoscope to augment visualization during microscopic craniotomy, whereas endoscopic-controlled uses the endoscope as the sole visualization (e.g., transnasal pituitary)." — Jerry Grant (clinical) [Ep 2 · 0:33](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=33)
- "A rigid endoscope holding arm is necessary for endoscopic-assist cases to free the surgeon's hands and maintain spatial awareness in the limited craniotomy field." — Jerry Grant (clinical) [Ep 2 · 2:31](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=151)
- "Rigid scopes are preferred over flexible scopes in endoscopic-assist settings due to superior optics and lower risk of damage during extraction." — Jerry Grant (opinion) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=180)
- "Insertion and removal of the endoscope are the riskiest phases; the surgeon must watch the scope under the microscope rather than the endoscopic screen to avoid injury to the frontal lobe, olfactory nerves, optic chiasm, or carotid." — Jerry Grant (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=210)
- "Spatial awareness is critical in endoscopic-assist because the surgeon cannot see behind the scope; structures posterior to the scope tip are invisible." — Jerry Grant (clinical) [Ep 2 · 4:30](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=270)
- "Angled rigid scopes (30° and 70°) allow visualization around corners and beneath structures (e.g., optic chiasm) that would otherwise require retraction or repositioning." — Jerry Grant (clinical) [Ep 2 · 7:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=420)
- "For sellar/suprasellar craniopharyngiomas, approach selection (transnasal vs. cranial) depends on patient age, sphenoid ossification, nares size, and pituitary function." — Jerry Grant (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=480)
- "Endoscopic assist from a subfrontal or transciliary approach can reproduce the view obtained transnasally, allowing visualization beneath the optic chiasm and into the third ventricle." — Jerry Grant (clinical) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=540)
- "Direct endoscopic visualization of the hypothalamic-capsule interface during craniopharyngioma resection reduces the risk of hypothalamic injury compared to blind pulling of the capsule." — Jerry Grant (clinical) [Ep 2 · 10:40](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=640)
- "Over the years, surgeons have become more conservative in managing the hypothalamic portion of craniopharyngiomas that extend into the third ventricle, often leaving capsule behind." — Jerry Grant (clinical) [Ep 2 · 12:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=720)
- "The transciliary eyebrow incision with small orbitotomy and zygomatic work provides a low corridor to the anterior cranial fossa, suitable for endoscopic-assist or endoscopic-controlled approaches." — Jerry Grant (clinical) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=780)
- "Grant's series includes approximately 120 transciliary approaches to the anterior cranial fossa." — Jerry Grant (epidemiological) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=780)
- "The transciliary approach allows access to the pituitary stalk for biopsy (e.g., for thickened stalk lesions such as germinoma, Langerhans cell histiocytosis, or lymphocytic hypophysitis) without moving the chiasm or carotid." — Jerry Grant (clinical) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=840)
- "Endoscopic assist provides better illumination and magnification in deep corridors where the microscope's light and optics are limited." — Jerry Grant (clinical) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=900)
- "The 0° endoscope is used initially for illumination and direct visualization, then 30° and 70° scopes are used to look around corners; higher angles require greater spatial awareness." — Jerry Grant (clinical) [Ep 2 · 16:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=960)
- "Studies suggest a potentially higher infection risk with endoscopic assist for primary shunt placement, though the evidence is not definitive." — Jerry Grant (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1020)
- "Grant does not routinely use endoscopic assist for primary shunt placement but uses it routinely for shunt revisions." — Jerry Grant (clinical) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1050)
- "For shunt revisions in slit-ventricle patients, 1mm rigid endoscopes allow the surgeon to follow the old shunt tract, visualize the ventricle, and place a new catheter without dissecting into white matter." — Jerry Grant (clinical) [Ep 2 · 17:50](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1070)
- "Endoscopic assist for shunt revision avoids the need for image guidance (e.g., BrainLab, Stealth) by providing direct visualization along the old tract." — Jerry Grant (clinical) [Ep 2 · 17:50](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1070)
- "In endoscopic-assist cases, the rigid endoscope is used purely as an optical device, not for instrument passage." — Jerry Grant (clinical) [Ep 2 · 18:46](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1126)
- "Endoscope tips heat up during use and should not be placed directly against the carotid or other vascular structures to avoid thermal injury." — Jerry Grant (clinical) [Ep 2 · 19:20](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1160)
- "The surgical field should be kept moist during endoscope insertion to prevent the scope from sticking to perforators or other structures." — Jerry Grant (clinical) [Ep 2 · 19:50](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1190)
- "Grant does not use a sheath for endoscopic-assist cases (open craniotomy) but does use a sheath for endoscopic-controlled intraventricular cases to protect the cortex during insertion and removal." — Jerry Grant (clinical) [Ep 2 · 19:20](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1160)
- "Future developments in 3D endoscope technology and augmented reality may improve spatial understanding and optics in endoscopic-assist surgery." — Jerry Grant (opinion) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/endoscopic-assist-for-pediatric-tumors-vascular-and-hydrocephalus-383?t=1050)
- "Over 80% of pediatric brain tumors are curable, including both benign and malignant tumors." — Erin Keena (epidemiological) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=85)
- "The immature pediatric brain is still undergoing myelination, and while cells may be more vulnerable to injury, there is ongoing neuroplasticity, synaptogenesis, and synaptic pruning allowing for unique recovery from surgery." — Erin Keena (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=85)
- "Modern WHO guidelines now include genomic and molecular analysis requirements for multiple tumor types, necessitating adequate tissue preservation." — Erin Keena (guideline) [Ep 3 · 2:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=150)
- "All brain tissue is relevant; there is not just eloquent and non-eloquent cortex, and all fiber tracts en route to lesions must be preserved regardless of corridor." — Erin Keena (opinion) [Ep 3 · 3:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=200)
- "From awake craniotomy data, 90% of new intraoperative neurological deficits occur during subcortical dissection." — Erin Keena (clinical) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=280)
- "A parafascicular trajectory minimizes shear forces applied to white matter tracts by running parallel to the main white matter tracts." — Erin Keena (clinical) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=320)
- "A trans-sulcal route with parafascicular trajectory reduces the amount of brain traversed en route to reach lesions." — Erin Keena (clinical) [Ep 3 · 6:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=360)
- "Using a tubular retractor distributes forces radially, thereby protecting displaced tissue rather than simply retracting with malleable retractors." — Erin Keena (clinical) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=390)
- "Traditional craniotomies can cause brain collapse in children with large ventricles after corpus callosotomy, leading to CSF egress into subdural space, pseudomeningocele development, and prolonged recoveries." — Erin Keena (clinical) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=540)
- "Pure endoscopic resection is limited by inability to achieve simultaneous hemostasis, restriction to one-handed technique, poor retraction capability, and requirement to remove tumor in very small pieces or morsellate with devices." — Erin Keena (clinical) [Ep 3 · 9:50](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=590)
- "BrainPath approach requires a small craniotomy 2.5 to 3 centimeters in diameter and has a slightly restrictive field requiring extra-long keyhole instruments." — Erin Keena (clinical) [Ep 3 · 10:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=630)
- "The port cannot be moved around significantly once in place or it will disrupt fiber tracts." — Erin Keena (clinical) [Ep 3 · 10:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=630)
- "Ideal BrainPath cases are lesions less than 4 centimeters that can be accessed down the long axis through a parafascicular corridor, including subcortical, deep, or metastatic lesions." — Erin Keena (opinion) [Ep 3 · 11:10](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=670)
- "In Dr. Keena's personal series, mean operative time was 3 hours and 11 minutes with median length of stay of 48 hours." — Erin Keena (clinical) [Ep 3 · 15:50](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=950)
- "In Dr. Keena's personal series, extent of resection matched intended resection in every case." — Erin Keena (clinical) [Ep 3 · 16:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=980)
- "In Dr. Keena's personal series, all patients were neurologically intact with the exception of one pre-existing visual field deficit." — Erin Keena (clinical) [Ep 3 · 16:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=980)
- "The broader BrainPath series includes over 200 cases used throughout the brain, predominantly for supratentorial indications including primary tumors and metastases." — Erin Keena (clinical) [Ep 3 · 16:49](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1009)
- "BrainPath resection is safe and efficacious with similar or improved outcomes and shorter lengths of stay compared to traditional approaches." — Erin Keena (opinion) [Ep 3 · 16:49](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1009)
- "For trans-sulcal BrainPath passage, the arachnoid is opened up to about 2 centimeters (though only 15mm is needed), then the patient is placed under Valsalva without mannitol or CSF pressure relief, the opening is widened with bipolar tips, and the blunt trocar is passed under navigation." — Erin Keena (clinical) [Ep 3 · 19:22](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1162)
- "The blunt tip of the BrainPath trocar allows vessels to roll off radially, and Dr. Keena has not ruptured any veins or arteries using this technique." — Erin Keena (clinical) [Ep 3 · 20:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1240)
- "The Nico Myriad preserves tissue architecture by morsellating tissue and provides the smallest obstruction in the surgical view due to its streamlined handpiece." — Erin Keena (clinical) [Ep 3 · 17:14](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1034)
- "The exoscope provides more options for patient head positioning and approach angle compared to the microscope, which requires careful positioning so the port is as superior as possible for ergonomic downward viewing." — Erin Keena (clinical) [Ep 3 · 17:14](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1034)
- "Removing choroid plexus tumors en bloc with BrainPath preserves the architecture for pathologists to make critical diagnoses, unlike morsellation into small pieces." — Erin Keena (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=850)

## Changelog
- Sep 15: 3 items added automatically

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