scholarly journals Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors

2016 ◽  
Vol 41 (6) ◽  
pp. E13 ◽  
Author(s):  
Ruth Prieto ◽  
José María Pascual ◽  
Maria Rosdolsky ◽  
Inés Castro-Dufourny ◽  
Rodrigo Carrasco ◽  
...  
Keyword(s):  
Adhesion Strength ◽  
Surgical Outcomes ◽  
Third Ventricle ◽  
Optic Chiasm ◽  
Anatomical Location ◽  
Brain Invasion ◽  
Model Based ◽  
Related Risk ◽  
Hypothalamic Injury ◽  
Tumor Consistency

OBJECTIVE Craniopharyngioma (CP) adherence strongly influences the potential for achieving a radical and safe surgical treatment. However, this factor remains poorly addressed in the scientific literature. This study provides a rational, comprehensive description of CP adherence that can be used for the prediction of surgical risks associated with the removal of these challenging lesions. METHODS This study retrospectively analyzes the evidence provided in pathological, neuroradiological, and surgical CP reports concerning 3 components of the CP attachment: 1) the intracranial structures attached to the tumor; 2) the morphology of the adhesion; and 3) the adhesion strength. From a total of 1781 CP reports published between 1857 and 2016, a collection of 500 CPs providing the best information about the type of CP attachment were investigated. This cohort includes autopsy studies (n = 254); surgical studies with a detailed description or pictorial evidence of CP adherence (n = 298); and surgical CP videos (n = 61) showing the technical steps for releasing the attachment. A predictive model of CP adherence in hierarchical severity levels correlated with surgical outcomes was generated by multivariate analysis. RESULTS The anatomical location of the CP attachment occurred predominantly at the third ventricle floor (TVF) (54%, n = 268), third ventricle walls (23%, n = 114), and pituitary stalk (19%, n = 94). The optic chiasm was involved in 56% (n = 281). Six morphological patterns of CP attachment were identified: 1) fibrovascular pedicle (5.4%); 2) sessile or patch-like (21%); 3) cap-like (over the CP top, 14%); 4) bowl-like (around the CP bottom, 13.5%); 5) ring-like (encircling central band, 19%); and 6) circumferential (enveloping the entire CP, 27%). Adhesion strength was classified in 4 grades: 1) loose (easily dissectible, 8%); 2) tight (requires sharp dissection, 32%); 3) fusion (no clear cleavage plane, 40%); and 4) replacement (loss of brain tissue integrity, 20%). The types of CP attachment associated with the worst surgical outcomes are the ring-like, bowl-like, and circumferential ones with fusion to the TVF or replacement of this structure (p < 0.001). The CP topography is the variable that best predicts the type of CP attachment (p < 0.001). Ring-like and circumferential attachments were observed for CPs invading the TVF (secondary intraventricular CPs) and CPs developing within the TVF itself (infundibulo-tuberal CPs). Brain invasion and peritumoral gliosis occurred predominantly in the ring-like and circumferential adherence patterns (p < 0.001). A multivariate model including the variables CP topography, tumor consistency, and the presence of hydrocephalus, infundibulo-tuberal syndrome, and/or hypothalamic dysfunction accurately predicts the severity of CP attachment in 87% of cases. CONCLUSIONS A comprehensive descriptive model of CP adherence in 5 hierarchical levels of increased severity—mild, moderate, serious, severe, and critical—was generated. This model, based on the location, morphology, and strength of the attachment can be used to anticipate the surgical risk of hypothalamic injury and to plan the degree of removal accordingly.

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.

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.

Symptomatic Chronic Paroxysmal Hemicrania

Cephalalgia ◽  
1992 ◽  
Vol 12 (2) ◽  
pp. 111-113 ◽  
Author(s):  
N Vijayan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Third Ventricle ◽  
Sella Turcica ◽  
Paroxysmal Hemicrania ◽  
Anatomical Location ◽  
Partial Removal ◽  
The Third ◽  
Chronic Paroxysmal Hemicrania

A patient with chronic paroxysmal hemicrania (CPH) associated with a gangliocytoma growing from within the sella turcica is reported. This tumor displaced the floor of the third ventricle and surrounded the internal carotid artery on the same side as the headache. Partial removal of the tumor followed by radiation resulted in amelioration of headache. The anatomical location of the tumor and its possible relationship to the pathogenesis of CPH is discussed.

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.

scholarly journals Narcolepsy Secondary to Fourth Ventricular Subependymoma

1996 ◽  
Vol 23 (1) ◽  
pp. 59-62 ◽  
Author(s):  
T.K.F. Ma ◽  
L.C. Ang ◽  
M. Mamelak ◽  
S.J. Kish ◽  
B. Young ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Cerebral Metastasis ◽  
Histologic Examination ◽  
Colonic Carcinoma ◽  
Anatomical Location ◽  
Pathological Changes ◽  
The Third ◽  
Anatomical Localization ◽  
History Of

ABSTRACT:Background:Secondary (symptomatic) narcolepsy is rare. We report a subependymoma of the fourth ventricle associated with narcolepsy. The patient was a 50-year-old woman with a long history of narcolepsy who died of colonic carcinoma with no cerebral metastasis. She was positive for HLA-DR2. At autopsy there was a tumour dorsal to the fourth ventricle which involved the midbrain tectum and rostral pons. Histologic examination of the tumour confirmed it to be a subependymoma.Methods:Review of the previous cases of secondary narcolepsy was made with particular reference to the anatomical location of the lesions.Results:Most of the lesions were found around the third ventricle and rostral brainstem.Conclusions:Knowing the anatomical localization of the pathological changes in secondary narcolepsy could be important in improving our understanding of its pathogenesis.

Histological examination of kaolin-induced hydrocephalus

1979 ◽  
Vol 50 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Don R. DeFeo ◽  
Patti Myers ◽  
Eldon L. Foltz ◽  
Bruce Everett ◽  
Bruce Ramshaw
Keyword(s):  
Third Ventricle ◽  
Optic Chiasm ◽  
Cervical Cord ◽  
Csf Flow ◽  
Content Type ◽  
Foreign Substance ◽  
Upper Cervical ◽  
Biological Reaction ◽  
Subarachnoid Spaces ◽  
Pontomedullary Junction

✓ To determine the possible efficacy of distal subarachnoid space shunting in the treatment of hydrocephalus, the brains of dogs with kaolin-induced hydrocephalus were examined histologically to discover the location of the kaolin and the nature of any biological reaction to the foreign substance. Hydrocephalus was produced by the mechanical infusion of a sterile kaolin suspension into the cisterna magna. After sacrifice the brains were removed and sectioned at the upper cervical cord, pontomedullary junction, midbrain, and optic chiasm, then histologically studied and photographed. Kaolin deposition was most notably found ventral to the brain stem, approaching the foramen of Luschka, up to and within the third ventricle. Ventrally, the kaolin and subsequent inflammatory reaction extended from the chiasmatic cistern down throughout the pre-pontine cistern to surround the cervical cord. In these cases, the kaolin was not found in the lateral ventricles, nor did it extend above the basal and ambient cisterns to cause inflammation in the cortical subarachnoid spaces. Due to the failure of the kaolin and any accompanying reaction to reach the cerebral convexities, it can be concluded that these distal spaces are potentially functional and open to cerebrospinal fluid (CSF) flow and absorption. The pathophysiology of kaolin-induced hydrocephalus is then due to the inflammatory obstruction of the CSF pathways, preventing normal bulk CSF flow to the distal subarachnoid spaces of the cerebral hemispheres thus mimicking some forms of human hydrocephalus.

scholarly journals Prospective clinical validation of a meningioma consistency grading scheme: association with surgical outcomes and extent of tumor resection

2019 ◽  
Vol 131 (5) ◽  
pp. 1356-1360 ◽  
Author(s):  
Kyohei Itamura ◽  
Ki-Eun Chang ◽  
Joshua Lucas ◽  
Daniel A. Donoho ◽  
Steven Giannotta ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Tumor Resection ◽  
High Volume ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Duration Of Surgery ◽  
Grade 3 ◽  
Tumor Consistency

OBJECTIVEThe present study aims to assess the clinical utility of a previously validated intraoperative meningioma consistency grading scale and its association with extent of resection (EOR) and various surgical outcomes.METHODSThe previously validated grading system was prospectively assessed in 127 consecutive patients undergoing open craniotomy for meningioma by multiple neurosurgeons at two high-volume academic hospitals from 2013 to 2016. Consistency grading scores ranging from 1 (soft) to 5 (firm/calcified) were retrospectively analyzed to test for association with surgical outcomes and EOR, categorized as gross-total resection (GTR) or subtotal resection, defined by postoperative MRI.RESULTSOne hundred twenty-seven patients were included in the analysis with a tumor consistency distribution as follows: grade 1, 3.1%; grade 2, 14.2%; grade 3, 44.1%; grade 4, 32.3%; and grade 5, 6.3%. The mean tumor diameter was 3.6 ± 1.7 cm. Tumor consistency grades were grouped into soft (grades 1 and 2), average (grade 3), and firm (grades 4 and 5) groups for statistical analysis with distributions of 17.3%, 44.1%, and 38.6%, respectively. There was no association between meningioma consistency and maximal tumor diameter, or location. Mean duration of surgery was longer for tumors with higher consistency: grades 1 and 2, 186 minutes; grade 3, 219 minutes; and grades 4 and 5, 299 minutes (p = 0.000028). There was a trend toward higher perioperative complication rates for tumors of increased consistency: grades 1 and 2, 4.5%; grade 3, 7.0%; and grades 4 and 5, 20.8% (p = 0.047). The proportion of GTR for each consistency group was as follows: grades 1 and 2, 77%; grade 3, 68%; and grades 4 and 5, 43% (p = 0.0062).CONCLUSIONSIn addition to other important meningioma characteristics such as invasiveness, tumor consistency is a key determinant of surgical outcomes, including operative duration and EOR. Future studies predicting tumor consistency based on preoperative neuroimaging will help considerably with preoperative planning for meningiomas.

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.

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes

2020 ◽  
Author(s):  
Hissah K. Al Abdulsalam ◽  
Aljohara K. Aldahish ◽  
Abdulrahman Albakr ◽  
Sajjad Hussain ◽  
Ahmad Alroqi ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Outcomes ◽  
Transnasal Approach ◽  
Weighted Magnetic Resonance Imaging ◽  
Endoscopic Transnasal Approach ◽  
Cerebellar Peduncle ◽  
Magnetic Resonance Imaging Mri ◽  
Skull Base Meningiomas ◽  
Tumor Consistency ◽  
Traditional Approaches

Abstract Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3–2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

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