Anterior Interhemispheric Approach for 100 Tumors in and Around the Anterior Third Ventricle

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-65-ons-74 ◽  
Author(s):  
Tomokatsu Hori ◽  
Takakazu Kawamata ◽  
Kosaku Amano ◽  
Yasuo Aihara ◽  
Masami Ono ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Karnofsky Performance Scale ◽  
Subtotal Resection ◽  
Anterior Communicating Artery ◽  
Lamina Terminalis ◽  
Interhemispheric Approach ◽  
Anterior Interhemispheric Approach ◽  
Bridging Veins ◽  
Performance Scale

Abstract Objective: We report our experience with anterior interhemispheric approach for tumors in and around the anterior third ventricle, including surgical technique, instrumentation, pre- and postoperative hormonal disturbances, and resection rate. Methods: One hundred patients with 46 craniopharyngiomas, 12 hypothalamic gliomas, 12 meningiomas, 6 hypothalamic hamartomas, and 24 other lesions were operated on using an anterior interhemispheric approach with or without opening of the lamina terminalis. This surgical approach involves no frontal sinus opening; a narrow (approximately 15–20 mm in width) access between the bridging veins, which is sufficient to remove the tumor totally; and sparing of the anterior communicating artery. Specially designed long bipolar forceps and scissors are necessary for this approach, and concomitant use of angled instruments (endoscope, aspirator, and microforceps) is required frequently. The postsurgical follow-up period varied from 4 months to 18 years. Results: Total removal of the neoplasm was accomplished in 37 of 46 patients with craniopharyngiomas (80.4%), whereas subtotal resection was performed in hypothalamic gliomas. No significant differences in pre- and postoperative hormonal disturbances were observed in 37 craniopharyngiomas and 10 hypothalamic gliomas. There was no operative mortality. Visual acuity was preserved or improved in 68 of 75 patients assessed. The Karnofsky Performance Scale score did not deteriorate in 72 of 75 patients tested. Conclusion: The minimally invasive anterior interhemispheric approach, with or without opening of the lamina terminalis, is useful for removal of tumors in and around the anterior third ventricle, such as craniopharyngiomas and hypothalamic gliomas.

Bifrontal basal interhemispheric approach to craniopharyngioma resection with or without division of the anterior communicating artery

1996 ◽  
Vol 84 (6) ◽  
pp. 951-956 ◽  
Author(s):  
Masato Shibuya ◽  
Masakazu Takayasu ◽  
Yoshio Suzuki ◽  
Kiyoshi Saito ◽  
Kenichiro Sugita
Keyword(s):  
Late Complications ◽  
Pituitary Stalk ◽  
Anterior Communicating Artery ◽  
Operative Field ◽  
Content Type ◽  
Visual Improvement ◽  
Interhemispheric Approach ◽  
Anterior Interhemispheric Approach ◽  
Bridging Veins ◽  
Perforating Arteries

✓ The authors describe the use of a bifrontal basal interhemispheric approach with or without division of the anterior communicating artery (ACoA) for removal of large craniopharyngiomas. This approach is a more basal modification of the anterior interhemispheric approach, allowing preservation of most bridging veins. Since 1988, 22 patients underwent operations using this approach to achieve total or near-total excision of large craniopharyngiomas. Division of the ACoA was performed in 11 of 17 patients with retrochiasmatic tumors with no early or late complications related to division of the artery. There were no operative mortalities. Visual improvement (59%) and preservation of the pituitary stalk (64%) were achieved in a high percentage of patients. Preservation of the pituitary stalk correlated well with postoperative pituitary function. The bifrontal basal interhemispheric approach allowed a bilateral, wider operative field with better orientation and views of important neural structures and perforating arteries without requiring combination with other approaches. When the ACoA limited operative exposure, the artery could be divided safely. The authors discuss indications for, and advantages of, the bifrontal basal interhemispheric approach with or without division of the ACoA in the removal of large craniopharyngiomas.

scholarly journals Expanded Transsphenoidal Trans-Lamina Terminalis Approach to Tumors Extending Into the Third Ventricle: Technique Notes and a Single Institute Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Lei Cao ◽  
Wentao Wu ◽  
Jie Kang ◽  
Hui Qiao ◽  
Xiaocui Yang ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Radical Resection ◽  
Lamina Terminalis ◽  
Total Resection ◽  
The Third ◽  
Cerebrospinal Fluid Leaks ◽  
Ventricular Tumors ◽  
New Onset

ObjectThe trans lamina terminalis approach (TLTA) has been described as a way to remove third ventricular tumors. The aim of this paper was to analyze the feasible outcomes of TLTA applied to tumors extending into the third ventricle in our institute.MethodsSuprasellar tumors (n = 149) were treated by the extended endonasal approach from September 2019 to December 2020 in Beijing Tiantan Hospital. Eleven of the tumors were treated by TLTA or TLTA via the trans-chiasm-pituitary corridor (TCPC). The surgical technique notes of TLTA were described and indications and outcomes of the approach were analyzed.ResultsThere were 11 patients enrolled in the study, six with papillary craniopharyngiomas, two with adamantinomatous craniopharyngiomas, one with a germinal cell tumor (GCT), one with cavernous malformation and one with chordoid glioma. Four of the patients received a radical resection by TLTA alone, while seven of them received TLTA via the TCPC. Gross total resection was achieved in eight patients (72.7%), and partial resection in three patients (27.3%). Visual function was improved in four of the 11 patients (36.4%), was unchanged in five patients (45.5%), and deteriorated in two patients (18.2%). New-onset hypopituitarism occurred in seven patients (63.3%) and new-onset diabetes insipidus occurred in two patients (18.2%). Electrocyte imbalance were observed in six patients (54.5%) at post-operative week 2. There were no surgery-related deaths or cerebrospinal fluid leaks. Postoperative intracranial infection was observed in one patient (9.1%), and during the follow-up period, tumor recurrence occurred in one patient (9.1%).ConclusionThe expanded TLTA provides a feasible suprachiasm corridor to remove tumors extending into the third ventricle, especially for craniopharyngiomas. Sound understanding of the major strengths and limitations of this approach, as well as strategies for complication avoidance, is necessary for its safe and effective application.

Craniofacial approaches to large juvenile angiofibromas

2011 ◽  
Vol 8 (1) ◽  
pp. 71-78 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Maziyar A. Kalani ◽  
Samuel Kalb ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Average Duration ◽  
Karnofsky Performance Scale ◽  
Preoperative Embolization ◽  
Large Juvenile ◽  
Csf Leakage ◽  
Scale Scores ◽  
Duration Of Hospitalization ◽  
Performance Scale ◽  
Related Mortality

Object Craniofacial approaches provide excellent exposure to lesions in the anterior and middle cranial fossae. The authors review their experience with craniofacial approaches for resection of large juvenile nasopharyngeal angiofibromas. Methods Between 1992 and 2009, 22 patients (all male, mean age 15 years, range 9–27 years) underwent 30 procedures. These cases were reviewed retrospectively. Results Gross-total resection of 17 (77%) of the 22 lesions was achieved. The average duration of hospitalization was 8.2 days (range 3–20 days). The rate of recurrence and/or progression was 4 (18%) of 22, with recurrences occurring a mean of 21 months after the first resection. All patients underwent preoperative embolization. Nine patients (41%) developed complications, the most common of which was CSF leakage (23%). The average follow-up was 27.7 months (range 2–144 months). The surgery-related mortality rate was 0%. Based on their mean preoperative (90) and postoperative (90) Karnofsky Performance Scale scores, 100% of patients improved or remained the same. Conclusions The authors' experience shows that craniofacial approaches provide an excellent avenue for the resection of large juvenile nasopharyngeal angiofibromas, with acceptable rates of morbidity and no deaths.

Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery

1986 ◽  
Vol 64 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Jiro Suzuki ◽  
Kazuo Mizoi ◽  
Takashi Yoshimoto
Keyword(s):  
Cerebral Arteries ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Early Operations ◽  
Temporary Clip ◽  
Fine Print

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.

Frontobasal Interhemispheric Trans-Lamina Terminalis Approach for Suprasellar Lesions

2005 ◽  
Vol 56 (suppl_4) ◽  
pp. ONS-418-ONS-424 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Nicolas de Tribolet
Keyword(s):  
Patient Selection ◽  
Surgical Approach ◽  
Postoperative Care ◽  
Operative Technique ◽  
Third Ventricle ◽  
Lamina Terminalis ◽  
The Third ◽  
Interhemispheric Approach

Abstract THE FRONTOBASAL INTERHEMISPHERIC APPROACH for suprasellar tumors currently incorporates technological advancements and refinements in patient selection, operative technique, and postoperative care. This technique is a valid choice for the removal of suprasellar lesions with extension into the third ventricle without major sequelae related to the surgical approach. The method described here reflects the combination of the frontal interhemispheric and trans-lamina terminalis approaches.

Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas

Neurosurgery ◽  
2015 ◽  
Vol 79 (1) ◽  
pp. 58-68 ◽  
Author(s):  
Or Cohen-Inbar ◽  
Cheng-chia Lee ◽  
David Schlesinger ◽  
Zhiyuan Xu ◽  
Jason P. Sheehan
Keyword(s):  
Skull Base ◽  
Tumor Volume ◽  
World Health ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Health Organization ◽  
Skull Base Meningiomas ◽  
Performance Scale

Abstract BACKGROUND: Gamma knife radiosurgery (GKRS) is well established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking. OBJECTIVE: To report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS. METHODS: From a prospectively collected institutional review board-approved database, we selected patients with a World Health Organization grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow-up. One hundred thirty-five patients, 54.1% males (n = 73), form the cohort. Median age was 54 years (19–80). Median tumor volume was 4.7 cm3 (0.5–23). Median margin dose was 15 Gy (7.5–36). Median follow-up was 102.5 months (60.1–235.4). Patient and tumor characteristics were assessed to determine the predictors of neurological function and tumor progression. RESULTS: At last follow-up, tumor volume control was achieved in 88.1% (n = 119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5-, 10-, and 15-year actuarial progression-free survival rates were 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n = 79). Pre-GKRS performance status (Karnofsky Performance Scale) was shown to influence tumor progression (P = .001) and post-GKRS clinical improvement/preservation (P = .003). CONCLUSION: GKRS offers a highly durable rate of tumor control for World Health Organization grade I skull base meningiomas, with an acceptably low incidence of neurological deficits. The Karnofsky Performance Scale at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.

Long-term outcome of Gamma Knife stereotactic radiosurgery for arteriovenous malformations graded by the Spetzler-Martin classification

2013 ◽  
Vol 118 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Michael T. Koltz ◽  
Adam J. Polifka ◽  
Andreas Saltos ◽  
Robert G. Slawson ◽  
Young Kwok ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Lesion Size ◽  
Karnofsky Performance Scale ◽  
The Mean ◽  
Gamma Knife Stereotactic Radiosurgery ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale

Object The object of this study was to assess outcomes in patients with arteriovenous malformations (AVMs) treated by Gamma Knife stereotactic radiosurgery (SRS); lesions were stratified by size, symptomatology, and Spetzler-Martin (S-M) grade. Methods The authors performed a retrospective analysis of 102 patients treated for an AVM with single-dose or staged-dose SRS between 1993 and 2004. Lesions were grouped by S-M grade, as hemorrhagic or nonhemorrhagic, and as small (< 3 cm) or large (≥ 3 cm). Outcomes included death, morbidity (new neurological deficit, new-onset seizure, or hemorrhage/rehemorrhage), nidus obliteration, and Karnofsky Performance Scale score. Results The mean follow-up was 8.5 years (range 5–16 years). Overall nidus obliteration (achieved in 75% of patients) and morbidity (19%) correlated with lesion size and S-M grade. For S-M Grade I–III AVMs, nonhemorrhagic and hemorrhagic combined, treatment yielded obliteration rates of 100%, 89%, and 86%, respectively; high functional status (Karnofsky Performance Scale Score ≥ 80); and 1% mortality. For S-M Grade IV and V AVMs, outcomes were less favorable, with obliteration rates of 54% and 0%, respectively. The AVMs that were not obliterated had a mean reduction in nidus volume of 69% (range 35%–96%). On long-term follow-up, 10% of patients experienced hemorrhage/rehemorrhage (6% mortality rate), which correlated with lesion size and S-M grade; the mean interval to hemorrhage was 81 months. Conclusions For patients with S-M Grade I–III AVMs, SRS offers outcomes that are favorable and that, except for the timing of obliteration, appear to be comparable to surgical outcomes reported for the same S-M grades. Staged-dose SRS results in lesion obliteration in half of patients with S-M Grade IV lesions.

Cavernous Malformations in and Around the Third Ventricle: Indications, Approaches, and Outcomes

2019 ◽  
Vol 18 (6) ◽  
pp. 736-746
Author(s):  
M Neil Woodall ◽  
Joshua S Catapano ◽  
Michael T Lawton ◽  
Robert F Spetzler
Keyword(s):  
Third Ventricle ◽  
Lateral Wall ◽  
Clinical Results ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Presenting Symptoms ◽  
The Third

Abstract BACKGROUND Cavernous malformations in structures in and around the third ventricle are a challenging conceptual and surgical problem. No consensus exists on the ideal approach to such lesions. OBJECTIVE To perform a retrospective review of our institutional database to identify and evaluate approaches used to treat cavernous malformations located in and around the third ventricle. METHODS Information was extracted regarding lesion size and location, extent of resection, time to last follow-up, surgical approach, presenting symptoms, preoperative and postoperative neurological status, and specific approach-related morbidity. RESULTS All 39 neurosurgical operations (in 36 patients) were either an anterior interhemispheric (AIH) (44%, 17/39) or a supracerebellar infratentorial (SCIT) (56%, 22/39) approach. Gross-total resection was achieved in 23 of 39 procedures (59%), a near-total resection in 1 (3%), and subtotal resection in 15 (38%). For the 31 patients with at least 3 mo of follow-up, the mean modified Rankin Scale (mRS) score was 1.5. Of the 31 patients, 25 (81%) had an mRS score of 0 to 2, 4 had a mRS score of 3 (13%), and 1 each had a mRS score of 4 (3%) or 5 (3%). CONCLUSION Most approaches to cavernous malformations in and around the third ventricle treated at our institution have been either an AIH or a SCIT approach. The AIH approach was used for lesions involving the lateral wall of the third ventricle or the midline third ventricular floor, whereas the SCIT approach was used for lesions extending from the third ventricle into the dorsolateral midbrain, with acceptable clinical results.

Current Surgical Outcomes for Cranial Base Chordomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1355-1360 ◽  
Author(s):  
Salvatore Di Maio ◽  
Robert Rostomily ◽  
Laligam N. Sekhar
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Cranial Base ◽  
Controlled Study ◽  
Karnofsky Performance Scale ◽  
Free Survival ◽  
Entire Cohort ◽  
Significant Difference ◽  
Performance Scale

Abstract BACKGROUND: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. OBJECTIVE: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. METHODS: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. RESULTS: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). CONCLUSION: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.

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