Technical strategies for the transcallosal transforaminal approach to third ventricle tumors: expanding the operative corridor

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There are a number of surgical approaches to the third ventricle, each with advantages and disadvantages. Which approach to use depends on the location of the lesion within the ventricle, the goals of the operation, and the surgeon's experience. The authors present their results in children with a modified approach through the expanded foramen of Monro.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective study was conducted to identify and analyze all children who underwent what the authors term the “expanded transforaminal” approach to the third ventricle between 2010 and 2013. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twelve patients were identified (5 female, 7 male) with a mean age of 9 years (range 2–19 years). Two patients underwent gross-total resections, whereas 10 resections were less than total. There were no instances of venous infarction, significant intraoperative bleeding, or short-term memory deficits. Of the 12 patients, 7 suffered a total of 17 complications. Disruption of neuroendocrine function occurred in 4 patients: 2 with transient diabetes insipidus, 2 with permanent panhypopituitarism, and 1 with central hypothroidism (1 patient had 2 complications). The most common group of complications were CSF-related, including 2 patients requiring a new shunt. There was 1 approach-related injury to the fornix, which did not result in any clinical deficits. One child with an aggressive malignancy died of tumor progression 6 months after surgery. Of the remaining 11 patients, none have experienced tumor recurrence or progression to date.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The expanded transcallosal transforaminal approach is a safe and relatively easy method of exploiting a natural pathway to the third ventricle, but there remain blind zones in the anterosuperior and posterosuperior regions of the third ventricle.</jats:p></jats:sec>

Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

“…Several studies have demonstrated the safety of the technique and its insignificant cognitive repercussions. [2][3][4]7,8,15,21,22,28,30 Gaffan and Gaffan performed an extensive review of this topic and concluded that bilateral sectioning of the fornix causes memory deficits; however, there is no consistent evidence that unilateral sectioning of the fornix can affect memory.…”

“…30,38 There is evidence that a unilateral lesion of the fornix column has little or no impact on memory. 2,4,8,15,22,25,28,30,43 Various regions and structures participate in the memory circuit, and the fornix is just one of these structures. Changes to other parts of this circuit would therefore be necessary to establish a permanent memory deficit.…”

Conversion technique from neuroendoscopy to microsurgery in ventricular tumors: Technical note

“…[425] There are two main options for open craniotomy microsurgical approach to the third ventricle and anterior lateral ventricle tumors, that is, the transcortical transventricular approach and the interhemispheric transcallosal approach. [371923] Which approach to adopt may depend on the location of the lesion within the ventricle, the goals of the operation, and the surgeon's experience. [19] It does not seem to have any advantage to perform one over the other.…”

“…[371923] Which approach to adopt may depend on the location of the lesion within the ventricle, the goals of the operation, and the surgeon's experience. [19] It does not seem to have any advantage to perform one over the other. To the best of our knowledge, there is no prospective randomized trial comparing the results of these two microsurgical approaches.…”

Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

“…30,38 There is evidence that a unilateral lesion of the fornix column has little or no impact on memory. 2,4,8,15,22,25,28,30,43 Various regions and structures participate in the memory circuit, and the fornix is just one of these structures. Changes to other parts of this circuit would therefore be necessary to establish a permanent memory deficit.…”