Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970–1997

Abstract

Between the years 1970 and 1997, 112 patients with tumors of the lateral ventricle were operated on at the University of Ankara, School of Medicine, Department of Neurosurgery. Seventy-one patients (63.4%) were male and 41 patients (36.6%) female. Headache (35.7%), nausea and vomiting (22.3%) were the most common presenting complaints. Papilloedema (42.9%), motor and sensory loss (25%) were the most common findings at neurological examination. Complete tumor removal was accomplished in 38.4% of the patients. Histopathologically, the most commonly seen types of the tumor were ependymoma (25%) and astrocytoma (21.4%). Among the various approach, the anterior transcortical (53.6%) and the posterior transcortical (16%) were the most commonly used. Eleven patients were reoperated for tumor recurrence. After surgery, radiation therapy was also performed on fourty-two patients. The morbidity and mortality rates were considerably higher before 1976 when the use of microneurosurgical techniques was introduced. After this, our morbidity and mortality rates decreased dramatically. The overall surgical mortality rate was 7.1% before 1976; during the last 10 years (n:46), it was 6.5%. In this report, our choice of operative approaches and the results will be discussed.

Transcortical surgery for lateral ventricular tumors

“…These symptoms can include headache, imbalance, visual field deficits, memory difficulty, personality changes, cognitive impairment, weakness, and seizures. 9,16,23,25,30,35,40 The signs and symptoms prior to diagnosis in this series were typical of patients with largesized tumors located in the lateral ventricle. The majority of the patients were children who presented with signs of increased ICP.…”

“…48 Transcortical approaches to the lateral ventricle often broach the tracts of the visual pathways, resulting in varying degrees of temporary and permanent deficits (Tables 2-4). 16,30,35,40 The optic tract can be found in the superior medial region of the temporal horn as it courses toward the lateral geniculate body. The radiations then spread toward the calcarine cortex along the Meyer-Archambault loop in the superior and lateral aspect of the temporal horn and in the tapetum over the roof and lateral aspect of the atrium and occipital horn.…”

“…The superior parietal route is one of the best approaches for reaching the collateral trigone the posterior part of the body, atrium, and the glomus of the choroid plexus. 4,5,9,16,38 It has been used to reach vascular malformations in the trigone, as well as tumors. 4,32 I have effectively used this approach to resect tumors that extend into the atrium or posterior body from the thalamus.…”

“…Prior to the advent of microsurgery techniques, the mortality and morbidity rates were higher than those of the present day. 16 In early studies the authors reported mortality rates as high as 75%, mostly because result of intraoperative hemorrhage or cerebral edema. Exsanguination probably contributed to the poor outcome and high mortality rate in early series of children in whom choroid plexus tumors were excised.…”

“…43 Tumors in this location are generally slow growing and can become large before causing symptoms. 7,16,[35][36][37]43 Symptoms are produced only after there is obstruction of the normal CSF pathways, compression of the adjacent neural structures, or hydrocephalus induced by overproduction of CSF. 35,36,48 Complete resection of many, but not all, of these lesions is possible via the transcortical or transcallosal route.…”