Surgery in tumors of the lateral ventricles – last 8 years experience

Abstract Introduction: Tumors of the lateral ventricle are rare lesions including a large variety of benign or malignant tumors. These tumors could originate in the ventricular wall or arising and expanding within the lateral ventricle from the surrounding neural structures. The purpose of this study is to discuss postoperative results and factors that affected the preference for transcallosal or transcortical approach. Material and methods : We performed a retrospective study, lasted between 2005- 2013, that comprised 26 consecutive patients who underwent operation for lateral ventricle tumors. The main clinical symptoms and signs were associated with the localization and size of the tumors. Cerebral computed tomography and magnetic resonance imaging were used to determine the location and expansion of each tumor. The transcortical approach was used in 17 patients and the transcallosal approach was used in 9 patients. Results : Total tumor resection was achieved in 73% of cases (19 patients). Most frequent histological tumor’s type was glioblastoma, choroid plexus papilloma, ependymoma and meningioma. Signs of increased intracranial pressure were most dominant. One patient died because of postoperative intraventricular hemorrhage. Additional neurological deficits were seen in 3 patients and postoperative seizure occurred in three patients. One patient with preoperative hydrocephalus required ventriculoperitoneal shunting after tumor’s resection. Two patients developed postoperative epidural hematoma and one required reoperation. 15 of 26 patients received postoperative radiotherapy and 6 of them received adjuvant chemotherapy. The mean duration of postoperative evaluation was 24,32 (range 5-92). Excepting the cases with subtotal resection, two patients were reoperated for recurrences. Conclusions : The nature, size, location and vascularization of intraventricular tumors are the most important elements influencing the choice of surgical approach. Surgeons must evaluate all these factors and prefer the short and safe way to remove the tumor.

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Arteriovenous malformations of the lateral ventricle

Journal of Neurosurgery ◽

10.3171/jns.1985.63.2.0185 ◽

1985 ◽

Vol 63 (2) ◽

pp. 185-192 ◽

Cited By ~ 32

Author(s):

Shiro Waga ◽

Shinichi Shimosaka ◽

Tadashi Kojima

Keyword(s):

Lateral Ventricle ◽

Intraventricular Hemorrhage ◽

Arteriovenous Malformations ◽

Vascular Lesion ◽

Neurological Deficits ◽

Middle Temporal Gyrus ◽

Content Type ◽

Transcallosal Approach ◽

Transcortical Approach ◽

Fine Print

✓ Nine cases with arteriovenous malformations (AVM's) predominantly involving the lateral ventricle are presented. All the AVM's were small, but caused intraventricular hemorrhage in eight cases. Only two patients had an intracerebral hemorrhage large enough to warrant evacuation. Eight patients were under the age of 40 years at the onset of their disease. Computerized tomography demonstrated intraventricular hemorrhage in eight patients, and after intravenous administration of contrast medium a small area of enhancement with dilated subependymal draining veins was seen in seven. The lateral ventricles were of normal size in seven cases, and only two patients required a shunting procedure. Angiography demonstrated that the lesion was an AVM in eight patients, and did not visualize the lesion in the ninth. One patient suffered a recurrent intraventricular hemorrhage when the AVM was demonstrated, although repeated angiography had failed to disclose a vascular lesion at his first intraventricular hemorrhage 14 months before. All nine lesions were resected by microsurgical techniques, and the results were excellent in eight patients. Of four caudate lesions, three were resected through a frontal transcortical approach and the other was operated on through an anterior transcallosal approach; the results were excellent in three of these patients. Only one (Case 4) was left with neurological deficits; he had confusion and disorientation following a right frontal transcortical approach. Even in the dominant hemisphere, lesions in the head of the caudate nucleus could be safely resected by an anterior transcallosal approach. Two choroidal lesions located in the temporal horn and trigone on the dominant side were resected through a middle temporal gyrus approach, and three thalamic lesions through a posterior transcallosal approach, all with excellent results. In all cases the brain opening required was about the width of the retractor (maximum 2.0 cm, average 1.5 cm).

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Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

Journal of Neurosurgery ◽

10.3171/jns.2000.92.2.0235 ◽

2000 ◽

Vol 92 (2) ◽

pp. 235-241 ◽

Cited By ~ 130

Author(s):

Madjid Samii ◽

Marcos Tatagiba ◽

Gustavo A. Carvalho

Keyword(s):

Tumor Resection ◽

Neurological Deficits ◽

Subtotal Resection ◽

Middle Fossa ◽

Meckel’S Cave ◽

Content Type ◽

Simpson Grade ◽

Petroclival Meningiomas ◽

Meckel's Cave ◽

Fine Print

Object. The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).Methods. The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.Conclusions. Theapproach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

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Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

Neurosurgical FOCUS ◽

10.3171/foc.1999.7.6.1 ◽

1999 ◽

Vol 7 (6) ◽

pp. E1

Author(s):

Madjid Samii ◽

Marcos Tatagiba ◽

Gustavo A. Carvalho

Keyword(s):

Tumor Resection ◽

Petrous Bone ◽

Neurological Deficits ◽

Subtotal Resection ◽

Middle Fossa ◽

Meckel’S Cave ◽

Simpson Grade ◽

Petroclival Meningiomas ◽

Meckel's Cave

Object The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA). Methods The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa. Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients. Conclusions The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

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Intraoperative use of heads-up display in skull base surgery

Neurosurgical Focus: Video ◽

10.3171/2021.10.focvid21177 ◽

2022 ◽

Vol 6 (1) ◽

pp. V2

Keyword(s):

Virtual Reality ◽

Skull Base ◽

Skull Base Surgery ◽

Tumor Resection ◽

Neurological Deficits ◽

Neurophysiological Monitoring ◽

Subtotal Resection ◽

Reduce Blood Loss ◽

Tumor Embolization ◽

Anterior Choroidal

In this video, the authors highlight the applications of virtual reality and heads-up display in skull base surgery by presenting the case of a 45-year-old woman with an incidental large clinoid meningioma extending into the posterior fossa. The patient underwent preoperative endovascular tumor embolization to facilitate tumor resection and reduce blood loss, followed by a right pterional craniotomy. The use of intraoperative Doppler, intraoperative neurophysiological monitoring, and endoscope-assisted microsurgery is also featured. A subtotal resection was planned given tumor encasement of the posterior communicating and anterior choroidal arteries. No new neurological deficits were noted after the surgical procedure. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21177

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Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy

Neurosurgical Review ◽

10.1007/s10143-021-01506-4 ◽

2021 ◽

Author(s):

S. D. Adib ◽

J. M. Hempel ◽

K. Kandilaris ◽

F. Grimm ◽

R. Evangelista Zamora ◽

...

Keyword(s):

Choroid Plexus ◽

Tumor Resection ◽

Choroid Plexus Papilloma ◽

Distant Metastases ◽

Subtotal Resection ◽

Surgical Removal ◽

Computer Search ◽

Initial Symptoms ◽

Remnant Tumor ◽

Type 3

AbstractChoroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation.

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Analysis of the factors affecting the prognosis of glioma patients

Open Medicine ◽

10.1515/med-2019-0031 ◽

2019 ◽

Vol 14 (1) ◽

pp. 331-335 ◽

Cited By ~ 8

Author(s):

Jiancun Wang ◽

Guancheng Hu ◽

Xingyun Quan

Keyword(s):

Cox Regression ◽

Clinical Symptoms ◽

Karnofsky Performance Status ◽

Postoperative Radiotherapy ◽

Univariate Analysis ◽

Tumor Resection ◽

Tumor Grade ◽

Factors Affecting ◽

Cox Regression Analysis ◽

Advanced Tumor

AbstractThis retrospective study was carried out to investigate factors affecting the prognosis of gliomas for better management of treatment. Clinical data from 186 glioma patients treated in our hospital from January 2013 to June 2016 were analyzed. There was slightly more male than female patients in the cohort. The main clinical symptoms included sudden limb twitching, headache and fatigue, vomiting, vision reduction and speaking disorders. The malignancy was high and the prognosis was poor in the patients, with an overall survival rate of 54.84 % by October 2017. Univariate analysis showed that the prognosis was mainly affected by age, tumor grade, preoperative Karnofsky performance status (KPS), surgical method, postoperative radiotherapy and chemotherapy, and postoperative use of temozolomide (TMZ). Multivariate Cox regression analysis showed that the independent risk factors for the prognosis were old age (≥ 60), advanced tumor, partial tumor resection, KPS of < 70, no chemotherapy after operation and < 4 courses of postoperative TMZ. The prognosis is negatively affected by age, tumor grade, KPS, and partial tumor resection. Surgical resection combined with chemotherapy and multi-course use of TMZ prolongs the survival time of patients.

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Transcortical insular glioma resection: clinical outcome and predictors

Journal of Neurosurgery ◽

10.3171/2018.4.jns18424 ◽

2019 ◽

Vol 131 (3) ◽

pp. 706-716 ◽

Cited By ~ 3

Author(s):

N. U. Farrukh Hameed ◽

Tianming Qiu ◽

Dongxiao Zhuang ◽

Junfeng Lu ◽

Zhengda Yu ◽

...

Keyword(s):

Surgical Approach ◽

Neurological Outcome ◽

Patient Survival ◽

Tumor Resection ◽

Brain Regions ◽

Tumor Location ◽

Neurological Deficits ◽

Lower Grade ◽

Isocitrate Dehydrogenase 1 ◽

Transcortical Approach

OBJECTIVEInsular lobe gliomas continue to challenge neurosurgeons due to their complex anatomical position. Transcortical and transsylvian corridors remain the primary approaches for reaching the insula, but the adoption of one technique over the other remains controversial. The authors analyzed the transcortical approach of resecting insular gliomas in the context of patient tumor location based on the Berger-Sinai classification, achievable extents of resection (EORs), overall survival (OS), and postsurgical neurological outcome.METHODSThe authors studied 255 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Tumor molecular pathology, location, EOR, postoperative neurological outcome for each insular zone, and the accompanying OS were incorporated into the analysis to determine the value of this surgical approach.RESULTSLower-grade insular gliomas (LGGs) were more prevalent (63.14%). Regarding location, giant tumors (involving all insular zones) were most prevalent (58.82%) followed by zone I+IV (anterior) tumors (20.39%). In LGGs, tumor location was an independent predictor of survival (p = 0.003), with giant tumors demonstrating shortest patient survival (p = 0.003). Isocitrate dehydrogenase 1 (IDH1) mutation was more likely to be associated with giant tumors (p < 0.001) than focal tumors located in a regional zone. EOR correlated with survival in both LGG (p = 0.001) and higher-grade glioma (HGG) patients (p = 0.008). The highest EORs were achieved in anterior-zone LGGs (p = 0.024). In terms of developing postoperative neurological deficits, patients with giant tumors were more susceptible (p = 0.038). Postoperative transient neurological deficit was recorded in 12.79%, and permanent deficit in 15.70% of patients. Patients who developed either transient or permanent postsurgical neurological deficits exhibited poorer survival (p < 0.001).CONCLUSIONSThe transcortical surgical approach can achieve maximal tumor resection in all insular zones. In addition, the incorporation of adjunct technologies such as multimodal brain imaging and mapping of cortical and subcortical eloquent brain regions into the transcortical approach favors postoperative neurological outcomes, and prolongs patient survival.

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Radiotherapy for atypical meningiomas

Journal of Neurosurgery ◽

10.3171/2011.5.jns11112 ◽

2011 ◽

Vol 115 (4) ◽

pp. 811-819 ◽

Cited By ~ 88

Author(s):

Richard Mair ◽

Kevin Morris ◽

Ian Scott ◽

Thomas A. Carroll

Keyword(s):

Cox Regression ◽

Postoperative Radiotherapy ◽

Tumor Resection ◽

Subtotal Resection ◽

Who Grade ◽

Grade Ii ◽

Atypical Meningiomas ◽

Tumor Remnant ◽

First Time

Object The role of postoperative radiotherapy in patients undergoing first-time resection of WHO Grade II meningioma remains unclear as reflected by varied practices in published clinical studies and national professional surveys. Much of the relevant literature is based on pre-2000 WHO grading criteria for atypical meningiomas. Authors in this study set out to explore the role of postoperative radiotherapy in patients undergoing first-time surgery for WHO Grade II meningiomas diagnosed using revised WHO 2000 criteria, against a background of otherwise limited published literature on this issue. Methods The authors retrospectively collected data on 114 consecutive patients who underwent first-time resection of WHO Grade II atypical meningiomas diagnosed using 2000 WHO criteria, and who variably underwent postoperative radiotherapy according to individual surgeon practices. Outcomes, including radiological recurrence, were submitted to Kaplan-Meier and Cox regression analyses. Results Postoperative radiotherapy demonstrated a significant benefit only when patients who had undergone gross-total tumor resection and those who had undergone subtotal resection along with postoperative radiosurgery to the tumor remnant were excluded from analysis. Conclusions The authors have performed the largest study in the literature to examine the use of radiotherapy for WHO Grade II, atypical, meningiomas following a first-time resection. They suggest that radiotherapy is not appropriate after first-time resection of those lesions in which a gross-total resection (Simpson Grade 1 or 2) has been achieved. They also advise that any tumor remnant radiologically demonstrated on postoperative imaging should be treated with radiosurgery and that postoperative radiotherapy after a first-time resection should be reserved for tumor remnants too large for radiosurgery and for which a second staged operation is not planned.

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New-onset seizure during and after brain tumor excision: a risk assessment analysis

Journal of Neurosurgery ◽

10.3171/2017.2.jns162315 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1713-1718 ◽

Cited By ~ 4

Author(s):

Soliman Oushy ◽

Stefan H. Sillau ◽

Douglas E. Ney ◽

Denise M. Damek ◽

A. Samy Youssef ◽

...

Keyword(s):

Brain Tumor ◽

Clinical Status ◽

Tumor Resection ◽

Cortical Stimulation ◽

Neurological Deficits ◽

Control Group ◽

Subtotal Resection ◽

Tumor Patients ◽

Group 1 ◽

New Onset

OBJECTIVEProphylactic use of antiepileptic drugs (AEDs) in seizure-naïve brain tumor patients remains a topic of debate. This study aimed to characterize a subset of patients at highest risk for new-onset perioperative seizures (i.e., intraoperative and postoperative seizures occurring within 30 days of surgery) who may benefit from prophylactic AEDs.METHODSThe authors conducted a retrospective case-control study of all adults who had undergone tumor resection or biopsy at the authors’ institution between January 1, 2004, and June 31, 2015. All patients with a history of preoperative seizures, posterior fossa tumors, pituitary tumors, and parasellar tumors were excluded. A control group was matched to the seizure patients according to age (± 0 years). Demographic data, clinical status, operative data, and postoperative course data were collected and analyzed.RESULTSAmong 1693 patients who underwent tumor resection or biopsy, 549 (32.4%) had never had a preoperative seizure. Of these 549 patients, 25 (4.6%) suffered a perioperative seizure (Group 1). A total of 524 patients (95.4%) who remained seizure free were matched to Group 1 according to age (± 0 years), resulting in 132 control patients (Group 2), at an approximate ratio of 1:5. There were no differences between the patient groups in terms of age, sex, race, relationship status, and neurological deficits on presentation. Histological subtype (infiltrating glioma vs meningioma vs other, p = 0.041), intradural tumor location (p < 0.001), intraoperative cortical stimulation (p = 0.004), and extent of resection (less than gross total, p = 0.002) were associated with the occurrence of perioperative seizures.CONCLUSIONSWhile most seizure-naïve brain tumor patients do not benefit from perioperative seizure prophylaxis, such treatment should be considered in high-risk patients with supratentorial intradural tumors, in patients undergoing intraoperative cortical stimulation, and in patients in whom subtotal resection is likely.

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Spinal Cord Ependymoma: Radical Surgical Resection and Outcome

Neurosurgery ◽

10.1097/00006123-200211000-00010 ◽

2002 ◽

Vol 51 (5) ◽

pp. 1162-1174 ◽

Cited By ~ 136

Author(s):

Fadi Hanbali ◽

Daryl R. Fourney ◽

Eric Marmor ◽

Dima Suki ◽

Laurence D. Rhines ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Resection ◽

Tumor Resection ◽

Neurological Deficits ◽

Cervical Cord ◽

Subtotal Resection ◽

Low Grade ◽

En Bloc ◽

Spinal Cord Ependymoma ◽

Radical Surgical Resection

Abstract OBJECTIVE Several authors have noted increased neurological deficits and worsening dysesthesia in the postoperative period in patients with spinal cord ependymoma. We describe the neurological progression and pain evolution of these patients over the 1-year period after surgery. In addition, our favored method of en bloc tumor resection is illustrated, and the rate of complications, recurrence, and survival in this group of patients is addressed. METHODS We operated on 26 patients (12 male and 14 female) with low-grade spinal cord ependymomas between 1975 and 2001. The median age at diagnosis was 42 years. Tumors extended into the cervical cord in 13 patients, the thoracic cord in 7 patients, and the conus medullaris in 6 patients. Eleven patients had previous surgery and/or radiation therapy. RESULTS We achieved a gross total resection in 88% of patients, whereas 8% had a subtotal resection and 4% had a biopsy. Only 1 patient developed a recurrence over a mean follow-up period of 31 months. CONCLUSION We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.

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