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Egyptian Journal of Neurosurgery
Fig. 2 | Egyptian Journal of Neurosurgery

Fig. 2

From: Combined endoscopic third ventriculostomy and tumor biopsy in the management of pineal region tumors, safety considerations

Fig. 2

Shows the two burr-holes method. a Preoperative sagittal T1-weighted image with contrast. The red line represents the pathway for ETV, and the green line represents the pathway for tumor biopsy. The lines are more than 3 cm away from each other necessitating two separate burr-holes. b Endoscopic third ventriculostomy done first (arrow head). c A close up view through the posterior third ventricle showing pineal region tumor obstructing the aqueduct (arrow head). d Initial coagulation on ependymal lining. e Biopsy forceps (arrow head) is directed through the cauterized violated ependymal wall. f Obtaining biopsy from within the tumor under ependymal wall using biopsy forceps

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