scholarly journals Surgical nuances for removal of retrochiasmatic craniopharyngiomas via the transbasal subfrontal translamina terminalis approach

2010 ◽  
Vol 28 (4) ◽  
pp. E6 ◽  
Author(s):  
James K. Liu ◽  
Lana D. Christiano ◽  
Gaurav Gupta ◽  
Peter W. Carmel
Keyword(s):  
Third Ventricle ◽  
Optic Chiasm ◽  
Surgical Removal ◽  
Lamina Terminalis ◽  
First Line ◽  
The Third ◽  
Interpeduncular Cistern ◽  
Line Of Therapy ◽  
Subfrontal Approach ◽  
Total Tumor Removal

Giant craniopharyngiomas in the retrochiasmatic space are challenging tumors, given the location and surrounding vital structures. Surgical removal remains the first line of therapy and offers the best chance of cure. For tumors with extension into the retrochiasmatic space, the authors use the translamina terminalis corridor via the transbasal subfrontal approach. Although the lamina terminalis can be accessed via anterolateral approaches (pterional or orbitozygomatic), the surgical view of the optic chiasm is oblique and prevents adequate visualization of the ipsilateral wall of the third ventricle. The transbasal subfrontal approach, on the other hand, offers the major advantage of direct midline orientation and access to the third ventricle through the lamina terminalis. This provides the significant advantage of visualization of both walls of the third ventricle and hypothalamus as well as inferior midline access to the interpeduncular cistern to permit safe neurovascular dissection and total tumor removal. In this report, the authors describe the transbasal subfrontal translamina terminalis approach, with specific emphasis on technical surgical nuances in removing retrochiasmatic craniopharyngiomas. An illustrative video demonstrating the technique is also presented.

Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients

2011 ◽  
Vol 7 (4) ◽  
pp. 389-396 ◽  
Author(s):  
Mansoor Foroughi ◽  
Andrew Wong ◽  
Paul Steinbok ◽  
Ash Singhal ◽  
Michael A. Sargent ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Clinical Success ◽  
Third Ventricle ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
The Third ◽  
Interpeduncular Cistern ◽  
Endoscopic Third Ventriculostomy Success

Object The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV. Methods Magnetic resonance imaging in 38 consecutive patients treated between 2004 and 2010 was reviewed to assess displacement of the lamina terminalis and third ventricular floor prior to and following ETV. Displacements of the floor and lamina terminalis were judged qualitatively and quantitatively, using a newly created index, the Third Ventricular Morphology Index (TVMI). The association between the aforementioned morphological features and clinical success of ETV was analyzed. Results Ninety-six percent of patients in whom the authors preoperatively observed displacement of the lamina terminalis and the third ventricular floor were successfully treated with ETV. Displacements of the third ventricular floor and lamina terminalis, as judged qualitatively, correlated with the clinical success of ETV. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in the majority of successfully treated patients. Changes in third ventricular morphology preceded changes in other measures of third and lateral ventricular volume following ETV. Conclusions Assessment of third ventricular floor and lamina terminalis morphology is useful in predicting clinical success of ETV and in the follow-up in treated patients. The TVMI provided a quantitative assessment of the third ventricular morphology, which may be useful in equivocal cases and in research studies.

scholarly journals Subfrontal trans-lamina terminalis approach to a third ventricular craniopharyngioma

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Omar Choudhri ◽  
Steven D. Chang
Keyword(s):  
Third Ventricle ◽  
Optic Chiasm ◽  
Surgical Anatomy ◽  
Anterior Communicating Artery ◽  
Lamina Terminalis ◽  
Anterior Portion ◽  
The Third ◽  
Skull Base Approach ◽  
Neurovascular Structures ◽  
Visual Disturbances

Craniopharyngiomas are benign, partly cystic epithelial tumors that can rarely occur in a retrochiasmatic location with involvement of the third ventricle. The lamina terminalis is an important neurosurgical corridor to these craniopharyngiomas in the anterior portion of the third ventricle. We present a video case of a large midline suprasellar and third ventricular craniopharyngioma in a 32-year-old male with visual disturbances. The tumor was approached with a subfrontal translamina terminalis exposure, and a gross-total resection of the tumor was achieved. This surgery involved working through a lamina terminalis fenestration around the optic nerve, optic chiasm, optic tracts, and the anterior communicating artery complex. This video illustrates the techniques employed in performing a transbasal anterior skull base approach to the third ventricle and demonstrates vivid surgical anatomy of neurovascular structures around the lamina terminalis.The video can be found here: https://youtu.be/fCYMgx8SnKs.

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.

General concepts of hypothalamus-pituitary anatomy

2011 ◽  
pp. 71-81
Author(s):  
Ignacio Bernabeu ◽  
Monica Marazuela ◽  
Felipe F. Casanueva
Keyword(s):  
Median Eminence ◽  
Third Ventricle ◽  
Optic Chiasm ◽  
Perivascular Space ◽  
Ependymal Cells ◽  
The Third ◽  
Long Time ◽  
Central Grey Matter ◽  
Imaginary Line ◽  
The Brain

The hypothalamus is the part of the diencephalon associated with visceral, autonomic, endocrine, affective, and emotional behaviour. It lies in the walls of the third ventricle, separated from the thalamus by the hypothalamic sulcus. The rostral boundary of the hypothalamus is roughly defined as a line through the optic chiasm, lamina terminalis, and anterior commissure, and an imaginary line extending from the posterior commissure to the caudal limit of the mamillary body represents the caudal boundary. Externally, the hypothalamus is bounded rostrally by the optic chiasm, laterally by the optic tract, and posteriorly by the mamillary bodies. Dorsolaterally, the hypothalamus extends to the medial edge of the internal capsule (Fig. 2.1.1) (1). The complicated anatomy of this area of the central nervous system (CNS) is the reason why, for a long time, little was known about its anatomical organization and functional significance. Even though the anatomy of the hypothalamus is well established it does not form a well-circumscribed region. On the contrary, it is continuous with the surrounding parts of the CNS: rostrally, with the septal area of the telencephalon and anterior perforating substance; anterolaterally with the substantia innominata; and caudally with the central grey matter and the tegmentum of the mesencephalon. The ventral portion of the hypothalamus and the third ventricular recess form the infundibulum, which represents the most proximal part of the neurohypophysis. A bulging region posterior to the infundibulum is the tuber cinereum, and the zone that forms the floor of the third ventricle is called the median eminence. The median eminence represents the final point of convergence of pathways from the CNS on the peripheral endocrine system and it is supplied by primary capillaries of the hypophyseal portal vessels. The median eminence is the anatomical interface between the brain and the anterior pituitary. Ependymal cells lining the floor of the third ventricle have processes that traverse the width of the median eminence and terminate near the portal perivascular space; these cells, called tanycytes, provide a structural and functional link between the cerebrospinal fluid (CSF) and the perivascular space of the pituitary portal vessels. The conspicuous landmarks of the ventral surface of the brain can be used to divide the hypothalamus into three parts: anterior (preoptic and supraoptic regions), middle (tuberal region), and caudal (mamillary region). Each half of the hypothalamus is also divided into a medial and lateral zone. The medial zone contains the so-called cell-rich areas with well-defined nuclei. The scattered cells of the lateral hypothalamic area have long overlapping dendrites, similar to the cells of the reticular formation. Some of these neurons send axons directly to the cerebral cortex and others project down into the brainstem and spinal cord.

scholarly journals Extended Endoscopic Endonasal Resection of a Suprasellar and Third Ventricular Retrochiasmatic Craniopharyngioma with a Narrow Pituitary Gland–Optic Chiasm Interval: Techniques to Optimize Resection

2018 ◽  
Vol 79 (S 03) ◽  
pp. S252-S253
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Pituitary Gland ◽  
Third Ventricle ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Posterior Aspect ◽  
Endoscopic Endonasal ◽  
The Third ◽  
Extended Endoscopic Approach

AbstractThe extended endoscopic endonasal approach can be utilized to surgically treat pathology within the suprasellar space. This relies on a sufficient corridor and interval between the superior aspect of the pituitary gland and the optic chiasm. Tumors located in the retrochiasmatic space and within the third ventricle, however, may not have a widened interval through which to work. With mass effect on the superior and posterior aspect of the optic chiasm, the corridor between the chiasm and the pituitary gland might even be further narrowed. This may negate the possibility of utilizing the endoscopic endonasal approach for the management of pathology in this location. We present a case of a retrochiasmatic craniopharyngioma with a narrow resection corridor that was treated with the extended endoscopic approach and we review techniques to potentially overcome this limitation.The link to the video can be found at: https://youtu.be/ogRZj-aBqeQ.

Surgical removal of an ependymoma from the third ventricle of a cat

1999 ◽  
Vol 77 (10) ◽  
pp. 645-648 ◽  
Author(s):  
DJ SIMPSON ◽  
GB HUNT ◽  
PLC TISDALL ◽  
M GOVENDIR ◽  
S ZAKI ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Surgical Removal ◽  
The Third

INTRAOPERATIVE DIRECT THIRD VENTRICULOSTOMY AND AQUEDUCTAL STENTING IN DEEP-SEATED MIDLINE BRAIN TUMOR SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 256-267 ◽  
Author(s):  
David I. Pitskhelauri ◽  
Alexander N. Konovalov ◽  
Valeri N. Kornienko ◽  
Natalia K. Serova ◽  
Nikita V. Arutiunov ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Tumor Removal ◽  
The Third ◽  
Total Tumor Removal ◽  
Ventricular Shunting

Abstract OBJECTIVE Surgical resection of deep-seated midline brain tumors does not always resolve obstruction of cerebrospinal fluid pathways, and an additional operation—ventricular shunting—is required. To prevent postoperative obstructive hydrocephalus, we combine tumor removal and internal ventricular shunting in 1 stage. METHODS Between 2000 and 2006, 82 patients with deep-seated midline brain tumors (tumors of the third ventricle, pineal region, thalamus, upper brainstem, and superior half of the fourth ventricle) underwent 84 tumor resections with intraoperative internal ventricular shunting. Two types of intraoperative shunting were performed: direct third ventriculostomy with fenestration of the premammillary membrane of the third ventricle floor and Liliequist's membrane, 53 operations; and aqueductal stenting, 30 operations. In 1 patient, third ventriculostomy and aqueductal stenting were performed simultaneously. RESULTS As most of the tumors had an infiltrative growth pattern, gross total tumor removal was achieved in only 31% of patients in this series. There were no fatal outcomes related to the surgery. Follow-up data were collected in 73 patients (89%) and ranged from 2 to 68 months (median, 16 months). Additional shunting because of inadequate function of stoma or stent was performed in 13 patients at various times after surgery (median, 30 days). The Kaplan-Meier survival analysis demonstrated that at 12 and 24 months the intraoperative direct third ventriculostomy success rates were 67 and 61%, respectively; aqueductal stenting success rates were 93% at both 12 and 24 months. CONCLUSION Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

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.

scholarly journals Modified one-piece extended transbasal approach for translamina terminalis resection of retrochiasmatic third ventricular craniopharyngioma

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Skull Base ◽  
Third Ventricle ◽  
Blind Spot ◽  
Anterior Wall ◽  
Anterolateral Approach ◽  
Lamina Terminalis ◽  
Base Approach ◽  
The Third ◽  
Skull Base Approach ◽  
Midline Approach

Retrochiasmatic third ventricular craniopharyngiomas are formidable tumors to remove surgically. Access to the third ventricle can be achieved through the lamina terminalis corridor. A skull base approach to the lamina terminalis can be performed using either an anterolateral approach (orbitozygomatic, pterional, supraorbital) or a midline approach (extended transbasal, subfrontal). The major disadvantage of an anterolateral approach is the lack of visualization of the ipsilateral wall of the third ventricle and hypothalamus. However, a midline transbasal approach eliminates this blind spot thereby providing direct visualization of both ependymal walls for safe dissection of the tumor. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for translamina terminalis resection of a retrochiasmatic retroinfundibular craniopharyngioma within the third ventricle via a modified one-piece extended transbasal approach. This approach uses the standard bifrontal craniotomy and incorporates the anterior wall of the frontal sinus as a one-piece flap. The inferior limit of the osteotomy is based along the coronal contour of the anterior skull base which eliminates any bony overhang that can obstruct the line of sight to the lamina terminalis. Additional removal of the supraorbital bar is not necessary. The operative technique for this skull base approach and surgical nuances for craniopharyngioma resection are illustrated in this video atlas.The video can be found here: http://youtu.be/E3Bsp6dUdAE.

scholarly journals Mature Teratoma in the Third Ventricle: A Case Report and Review of the Literature

2021 ◽  
pp. 1-4
Author(s):  
Yanire Sánchez Medina ◽  
Yanire Sánchez Medina ◽  
Eric Robles Hidalgo ◽  
Jaime Domínguez Baez ◽  
Luis Gómez Perals
Keyword(s):  
Case Report ◽  
Germ Cell ◽  
Third Ventricle ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Optic Chiasm ◽  
Pineal Region ◽  
The Third ◽  
Histopathologic Evaluation ◽  
Cell Layers

Introduction: Germ Cell Tumors (GCT) represent less than 4% of primary brain tumors. They comprise Germaniums, Non-Germinomatous Germ Cell Tumors and Teratomas. Teratomas represent less than 20% of intracranial GCT. They are tumors of multipotential cells derived from all 3 germ cell layers, frequently arising in midline structures, most commonly in the pineal and suprasellar regions, with a clear excess of male cases and frequently found in children and young adults. We report a case of a mature teratoma in the third ventricle in a 37-year-old male. Case Report: We report a case of a 37-year-old male with a history of headache lasting up to 9 days and refractory to pharmacological treatment. The CT scan revealed a 20mm round hypodense lesion in the anterior third ventricle, with a punctate hyperdensity in the inferior pole causing biventricular hydrocephalus with no periventricular lucency and the MRI showed a well-defined encapsulated mass lesion attached to the roof of the third ventricle, isointense in T1WI with circumferential enhancement and hyperintense in T2WI. Gross total resection was performed. Histopathologic evaluation revealed a mature teratoma. There was no evidence of recurrence on follow up MRI at 2 years. Conclusion: Intracranial teratomas typically originate in midline structures from optic chiasm to pineal region. Presentation after the first two decades of life is exceptional. Complete surgical resection is the only curative treatment for pure mature teratomas. We report the case of a mature teratoma in a 37-year-old male with unusual radiological findings.

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