scholarly journals Transcallosal approach for third ventriculostomy and removal of midbrain cavernous malformation

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1
Author(s):  
William T. Couldwell
Keyword(s):  
Brain Stem ◽  
Young Woman ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Mass Effect ◽  
Third Ventriculostomy ◽  
Cavernous Malformations ◽  
Transcallosal Approach ◽  
The Third ◽  
Transforaminal Approach

Symptomatic brain stem cavernous malformations often present the dilemma of choosing an approach for their resection. Superior midline midbrain lesions are in a particularly challenging location, as they are less accessible via traditional lateral or posterior approaches. The author presents a case of a young woman who presented with a symptomatic cavernous malformation with surface presentation to the floor of the third ventricle. The lesion was causing sensory symptoms from local mass effect and hydrocephalus from occlusion of the Aqueduct of Sylvius. An approach was chosen to both perform a third ventriculostomy and remove the cavernous malformation. Through a right frontal craniotomy, a transcallosal–transforaminal approach was used to perform a third ventriculostomy. Through the same callosal opening, a subchoroidal approach was performed to provide access the cavernous malformation. The details of the procedure and nuances of technique are described in the narration.The video can be found here: http://youtu.be/zKKnehp7l2c.

scholarly journals Left Interhemispheric Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E154-E154
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Lateral Ventricle ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Mass Effect ◽  
Cavernous Malformations ◽  
Transcallosal Approach ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract Thalamic cavernous malformations pose variable surgical challenges given that the location and size of the lesion often determine the approach surgical trajectory. The patient in this case has a large thalamic cavernous malformation that results in a mass effect on the third ventricle and directly abuts the lateral ventricle. A small interhemispheric craniotomy is performed to allow for an anterior interhemispheric transcallosal approach to the lesion. The lateral ventricle is accessed, and the septum is removed to enhance visualization of the surgical field. A small rim of normal parenchyma on the lateral margin of the thalamus is transgressed, and the cavernous malformation is entered. The lesion is removed in a piecemeal manner. Use of counter traction assists with the piecemeal removal. The lighted suction is critical during inspection and manipulation of the lesion within the resection cavity given the limited lighting deep within the cavity. The lesion was removed completely, and postoperative imaging confirms gross total resection. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute.

Endoscopic Resection of Hemorrhaged Third Ventricle Cavernous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E51-E51
Author(s):  
Giorgio Palandri ◽  
Thomas Sorenson ◽  
Mino Zucchelli ◽  
Nicola Acciarri ◽  
Paolo Mantovani ◽  
...  
Keyword(s):  
Gold Standard ◽  
Intraventricular Hemorrhage ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Gross Total Resection ◽  
Vascular Lesions ◽  
Total Resection ◽  
Cavernous Malformations ◽  
The Third

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.

scholarly journals Anterior Interhemispheric Transcallosal Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E240-E241
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Complete Resection ◽  
Institutional Review Board ◽  
Transcallosal Approach ◽  
The Third ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract This patient had a large left ventral thalamic cavernous malformation abutting the third ventricle with evidence of recent hemorrhage. The patient was placed supine with the head in the horizontal position with the dependent hemisphere down to permit use of the anterior interhemispheric transcallosal approach. The lateral ventricle is entered, and the septum pellucidum is opened to prevent it from obstructing the surgical field. The deep cavernous malformation is located with stereotactic neuronavigation and removed piecemeal with the aid of lighted suckers and bipolars. Surgical visualization and postoperative imaging demonstrate a complete resection of the lesion, and the patient remained neurologically stable postoperatively. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Interhemispheric, Translamina Terminalis Approach for the Resection of Suprasellar Cavernous Malformation

2018 ◽  
Vol 79 (S 03) ◽  
pp. S278-S278
Author(s):  
Georgios Zenonos ◽  
Paul Gardner
Keyword(s):  
Outcome Measures ◽  
Vision Loss ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Recurrence Free Survival ◽  
Cavernous Malformations ◽  
Free Survival ◽  
The Third ◽  
Imaging Characteristics

Objectives The current video presents the nuances of an interhemispheric, translamina terminalis approach for the resection of suprasellar cavernous malformation. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team at a teaching academic institution. Participants The case refers to a 64-year-old female who presented with vision loss and confusion, and was found to have a suprasellar mass, with imaging characteristics consistent with a cavernous malformation of the third ventricle. Main Outcome Measures The main outcome measures consist of the reversal of the patient symptoms (vision loss and confusion), the recurrence-free survival based on imaging, as well as the absence of any complications. Results The patient's mental status improved slightly after surgery. There was no evidence of recurrence. Conclusions The interhemispheric, translamina terminalis approach is safe and effective for the resection of suprasellar cavernous malformations.The link to the video can be found at: https://youtu.be/z6RSAM_GnBA.

Experimental Third Ventriculostomy Performed Using Endovascular Surgical Techniques and Their Adaptation to Percutaneous Intradural Neuronavigation: Proof of Concept Cadaver Study

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 387-392 ◽  
Author(s):  
Michael B. Horowitz ◽  
Kamal Ramzipoor ◽  
Ajit Nair ◽  
Susan Miller ◽  
George Rappard ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Surgical Techniques ◽  
Cadaver Study ◽  
Brain Parenchyma ◽  
Third Ventriculostomy ◽  
General Anesthetic ◽  
The Third ◽  
Noncommunicating Hydrocephalus ◽  
Pass Through ◽  
The Brain

Abstract OBJECTIVE Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

scholarly journals Anterior endoscopic transcortical approach to a pineal region cavernous hemangioma

2021 ◽  
Vol 5 (1) ◽  
pp. V15
Author(s):  
Jiuhong Li ◽  
Jiaojiang He ◽  
Lunxin Liu ◽  
Liangxue Zhou
Keyword(s):  
Cavernous Hemangioma ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Pineal Region ◽  
Postoperative Adhesion ◽  
Third Ventriculostomy ◽  
Back Side ◽  
Coronal Suture ◽  
The Third ◽  
Transcortical Approach

A 57-year-old female presented with headache and dizziness for 3 months. Preoperative MRI revealed a lesion located at the pineal region and back side of the third ventricle, accompanied by hydrocephalus. The infratentorial supracerebellar approach may cause visuomotor, acousticomotor, and hearing disturbances. With the patient in a supine position, the authors used a frontal linear incision that was 3 cm anterior to the coronal suture and 2 cm away from the midline and an anterior endoscopic transcortical approach, which could achieve endoscopic third ventriculostomy, alleviating and preventing hydrocephalus due to postoperative adhesion and resection of the lesion at the same time. The pathological diagnosis was cavernous hemangioma. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID215.

scholarly journals Comparative analysis of anterior third ventricle approaches

2020 ◽  
pp. 544-549
Author(s):  
Deepak Kumar Singh ◽  
Kuldeep Yadav ◽  
Rakesh Kumar ◽  
Arun Kumar Singh ◽  
Vipin Kumar Chand
Keyword(s):  
Third Ventricle ◽  
Medical Science ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Colloid Cyst ◽  
Subtotal Resection ◽  
Common Symptom ◽  
Anatomical Landmarks ◽  
Transcallosal Approach ◽  
Transforaminal Approach

Background. Third ventricle tumors are uncommon and account for only 0.6 - 0.9% of all the brain tumors7. In 1921, Dandy was the first neurosurgeon who successfully removed a colloid cyst from the third ventricle through a posterior transcallosal approach. Despite their unfavourable locations, these tumours can be removed successfully by proper knowledge of anatomical landmarks and by choosing the appropriate approach. Methods. We performed a retrospective analysis of all patients (17 patients) who underwent surgery for anterior third ventricular masses between March 2018 to March 2020 in the Dr Ram Manohar Lohia Institute of Medical Science Lucknow, Uttar Pradesh. Results: The most common symptom in our cases was headache, which was present in all (100%) patients, nausea/vomiting in 7 (41%), history of recurrent episodes of drop attacks in 4 (23%), h/o seizure in 2 (11.7%), visual disturbance in 1 (5.4%), memory disturbance in 1 (5.4%) and urinary incontinence in 1 (5.4%) patient. 6 patients were operated with transcallosal-transforaminal approach, 1 patient was operated with transcallosal interforniceal approach, 3 patients were operated with transcortical-transforaminal approach, 1 patient was operated with subfrontal translamina terminalis approach, 1 patient was operated with transcallosal-transchoroidal approach, 5 patients were operated with endoscopically. Gross total excision was achieved in 15 (88%) patients while in 2 (11.7%) patients subtotal resection was done due to their adherence to choroid plexus and optic chiasm. The most common post-operative complication was endocrine dysfunction in the form of diabetes insipidus. Conclusions. Anterior Third ventricular tumours are mostly benign and best treatment modality is surgical resection. When we analyzed the results of various approaches, we found that despite their unfavourable location, the results were satisfactory for different tumours of different location in the anterior third ventricle, when treated with the carefully planned microsurgical or endoscopic approach with proper knowledge of anatomical landmarks.

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.

Histological analysis of the third ventricle floor in hydrocephalic and nonhydrocephalic brains: application to neuroendocrine complications following third ventriculostomy procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 178-181 ◽  
Author(s):  
R. Shane Tubbs ◽  
Eyas M. Hattab ◽  
Marios Loukas ◽  
Joshua J. Chern ◽  
Melissa Wellons ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Neuronal Cell ◽  
Third Ventriculostomy ◽  
Endocrine Dysfunction ◽  
The Third ◽  
Neuronal Cell Bodies ◽  
Potential Association ◽  
Significant Difference

Object Endocrine dysfunction following endoscopic third ventriculostomy (ETV) is rare, but it has been reported. In the present study the authors sought to determine the histological nature of the floor of the third ventricle in hydrocephalic brains to better elucidate this potential association. Methods Five adult cadaveric brains with hydrocephalus were examined. Specifically, the floors of the third ventricle of these specimens were studied histologically. Age-matched controls without hydrocephalus were used for comparison. Results Although it was thinned in the hydrocephalic brains, the floor of the third ventricle had no significant difference between the numbers of neuronal cell bodies versus nonhydrocephalic brains. Conclusions Although uncommon following ETV, endocrine dysfunction has been reported. Based on the present study, this is most likely to be due to the injury of normal neuronal cell bodies found in this location, even in very thinned-out tissue.

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