Reinvestigating Tumor–Ventricle Relationship of Craniopharyngiomas With Predominantly Ventricular Involvement: An Endoscopic Endonasal Series Based on Histopathological Assessment

ObjectiveCraniopharyngiomas (CPs) predominantly involving the third ventricle were commonly termed “intraventricular” lesions. The aim of this study was to clarify the anatomical relationship between the tumor and the third ventricle by both surgical and histological investigation.MethodsA retrospective review of primarily resected CPs by endoscopic endonasal surgery was performed. CPs with predominantly ventricular involvement were selected for study inclusion by preoperative imaging. The surgical procedure of each case was reviewed. The wholly removed tumor specimens were histologically analyzed, in all cases, to investigate the tumor–third ventricle relationship using hematoxylin and eosin, immunochemical, and immunofluorescence staining.ResultsTwenty-six primary CPs predominantly involving the third ventricle were selected from our series of 223 CPs treated by endoscopic endonasal surgery between January 2017 and March 2021. Gross-total resection was achieved in 24 (92.3%) of 26 patients, with achievement of near-total resection in the remaining patients. A circumferential layer of stretched third ventricle floor was identified surrounding the tumor capsule, which could be peeled off easily from the ventricle floor remnants at most areas of the plane of tumor attachment. Some portions of the tumor capsule tightly adhered to the third ventricle floor were removed together with the floor. A breach of various size was observed at the third ventricle floor after tumor removal in most cases, the floor remaining intact in only two cases (7.7%). Histological examination on marked portions of tumor capsule showed that the pia mater was frequently detected at most of the tumor–brain interface, except at the antero-frontal border of tumor contacting with the third ventricle floor. At this point, a layer of gliosis with various thickness was observed between the tumor and the neural tissue of the third ventricle floor.ConclusionCPs with predominantly ventricular involvement should be considered as lesions with an extraventricular, epi-pia topography rather than “intraventricular” or “subpial” topography. Accurate understanding of the relationship between the third ventricle and such tumors would predict the circumferential cleavage plane of dissection, and remind neurosurgeons of performing dissection along the safe surgical plane to achieve total tumoral resection with minimizing hypothalamic damage.

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Combined simultaneous endoscopic endonasal and microscopic transventricular surgery using a port retractor system for giant pituitary adenoma: A technical case report

Surgical Neurology International ◽

10.25259/sni_826_2020 ◽

2021 ◽

Vol 12 ◽

pp. 90

Author(s):

Erika Yamada ◽

Hiroyoshi Akutsu ◽

Hiroyoshi Kino ◽

Shuho Tanaka ◽

Hidetaka Miyamoto ◽

...

Keyword(s):

Pituitary Adenoma ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Tumor Resection ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma ◽

The Third ◽

Memory Disturbance

Background: We report a case of a giant pituitary adenoma with marked extension into the third ventricle that was successfully removed using combined simultaneous endoscopic endonasal surgery (EES) and microscopic transventricular port surgery. Case Description: A 47-year-old woman, who complained of memory disturbance, had a giant pituitary adenoma with marked extension into the third ventricle that was causing obstructive hydrocephalus. She underwent combined EES and microscopic transventricular surgery using a port retractor system. Most of the tumor was resected from the EES side with assistance from the transcranial side with minimum cortical trajectory damage. The tumor was completely excised without any complications. Conclusion: For giant pituitary adenoma with marked extension into the third ventricle, combined simultaneous EES and transventricular surgery using a port retractor system is effective to maximize the extent of tumor resection while also preventing complications. Using port surgery on the transcranial side, microscopic secure dissection is possible with minimum additional cortical damage.

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Meningiomas of the velum interpositum: surgical considerations

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.1.11 ◽

2003 ◽

Vol 15 (1) ◽

pp. 1-9 ◽

Cited By ~ 26

Author(s):

Alan P. Lozier ◽

Jeffrey N. Bruce

Keyword(s):

Third Ventricle ◽

Pineal Region ◽

Preoperative Imaging ◽

Cerebral Veins ◽

Pia Mater ◽

Posterior Portion ◽

Pineal Region Tumor ◽

The Third ◽

Supracerebellar Infratentorial Approach ◽

Velum Interpositum

Meningiomas of the third ventricle are a rare subtype of pineal region tumor that arise from the posterior portion of the velum interpositum, the double layer of pia mater that forms the roof of the third ventricle. The authors review the literature concerning these meningiomas and present a case in which the lesion was resected via the supracerebellar–infratentorial approach. The relationship of the tumor to the deep venous system and the splenium of the corpus callosum guides the selection of the most advantageous surgical approach. Posterior displacement of the internal cerebral veins demonstrated on preoperative imaging provides a strong rationale for use of the supracerebellar–infratentorial approach.

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Endoscopic Endonasal Treatment of Ostium of the Frontal Sinus and the Results of Endoscopic Surgery

American Journal of Rhinology ◽

10.2500/105065894781874449 ◽

1994 ◽

Vol 8 (2) ◽

pp. 67-70 ◽

Cited By ~ 9

Author(s):

Hiroshi Moriyama ◽

Masaya Fukami ◽

Kiyoshi Yanagi ◽

Nobuyoshi Ohtori ◽

Kensaku Kaneta

Keyword(s):

Frontal Sinus ◽

Chronic Sinusitis ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Sinus Disease ◽

The Third ◽

Ethmoidal Artery ◽

Anterior Ethmoidal Artery ◽

Postoperative Findings

We discuss a procedure for opening the nasofrontal duct and the postoperative findings in endoscopic endonasal surgery. The route of the anterior ethmoidal artery was also studied. The subjects of this study were 57 patients (105 sides) who had frontal sinus disease. The patients all underwent surgery for chronic sinusitis between 1990 and 1992. Patients undergoing revision surgery were excluded. All patients were operated on by the same surgeon. In each patient, following anterior and posterior ethmoidectomy, the frontal sinus ostial region was opened using a 70 endoscope, while carefully monitoring the anterior ethmoidal artery. The agger nasi was left intact. The cells around the ostium were opened using a curved suction tip and upward bent forceps, and the lamellae were removed to achieve the greatest possible communication with the frontal sinus. In 77 sides (73.4%), the communication between the frontal and ethmoidal sinuses was well maintained. The ostium was patent with edematous mucosa in 18 sides (17.1%). The opened ostium could not be confirmed due to presence of polyp, etc., in 10 sides (9.5%). During surgery, the route of the anterior ethmoidal artery was confirmed in 70.8%; and of these cases, it was located anterior to the third ground lamella in about 50%.

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Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience

Journal of Neurosurgery ◽

10.3171/2017.7.jns162783 ◽

2019 ◽

Vol 130 (2) ◽

pp. 368-378 ◽

Cited By ~ 2

Author(s):

Francisco Vaz-Guimaraes ◽

Maria Koutourousiou ◽

John R. de Almeida ◽

Elizabeth C. Tyler-Kabara ◽

Juan C. Fernandez-Miranda ◽

...

Keyword(s):

Cranial Base ◽

Csf Leak ◽

Subtotal Resection ◽

Total Removal ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Total Resection ◽

Endoscopic Endonasal ◽

Intracranial Infection ◽

Incomplete Removal

OBJECTIVEEpidermoid and dermoid cysts may be found along the cranial base and are commonly resected via open transcranial approaches. The use of endoscopic endonasal approaches for resection of these tumors has been rarely reported.METHODSThe authors retrospectively reviewed the medical records of 21 patients who underwent endoscopic endonasal surgery for epidermoid and dermoid cyst resection at the University of Pittsburgh Medical Center between January 2005 and June 2014. Surgical outcomes and variables that might affect the extent of resection and complications were analyzed.RESULTSTotal resection (total removal of cyst contents and capsule) was achieved in 8 patients (38.1%), near-total resection (total removal of cyst contents, incomplete removal of cyst capsule) in 9 patients (42.9%), and subtotal resection (incomplete removal of cyst contents and capsule) in 4 patients (19%). Larger cyst volume (≥ 3 cm3) and intradural location (15 cysts) were significantly associated with nontotal resection (p = 0.008 and 0.0005, respectively). In the whole series, surgical complications were seen in 6 patients (28.6%). No complications were observed in patients with extradural cysts. Among the 15 patients with intradural cysts, the most common surgical complication was postoperative CSF leak (5 patients, 33.3%), followed by postoperative intracranial infection (4 patients, 26.7%). Larger cysts and postoperative CSF leak were associated with intracranial infection (p = 0.012 and 0.028, respectively). Subtotal resection was marginally associated with intracranial infection when compared with total resection (p = 0.091). All patients with neurological symptoms improved postoperatively with the exception of 1 patient with unchanged abducens nerve palsy.CONCLUSIONSEndoscopic endonasal approaches may be effectively used for resection of epidermoid and dermoid cysts in carefully selected cases. These approaches are recommended for cases in which a total or near-total resection is possible in addition to a multilayer cranial base reconstruction with vascularized tissue to minimize the risk of intracranial infection.

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Endoscopic endonasal surgery outcomes for pediatric craniopharyngioma: a systematic review

Neurosurgical FOCUS ◽

10.3171/2019.10.focus19728 ◽

2020 ◽

Vol 48 (1) ◽

pp. E6 ◽

Cited By ~ 1

Author(s):

Sauson Soldozy ◽

Michelle Yeghyayan ◽

Kaan Yağmurlu ◽

Pedro Norat ◽

Davis G. Taylor ◽

...

Keyword(s):

Controlled Trial ◽

Case Series ◽

Surgical Approaches ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Total Resection ◽

Endoscopic Endonasal ◽

Randomized Controlled ◽

Retrospective Cohort Studies ◽

Surgery Outcomes

OBJECTIVEThe goal of this study was to systematically review the outcomes of endoscopic endonasal surgery (EES) for pediatric craniopharyngiomas so as to assess its safety and efficacy.METHODSA systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986 and 2019. All studies assessing outcomes following EES for pediatric craniopharyngiomas were included.RESULTSOf the total 48 articles identified in the original literature search, 13 studies were ultimately selected. This includes comparative studies with other surgical approaches, retrospective cohort studies, and case series.CONCLUSIONSEES for pediatric craniopharyngiomas is a safe and efficacious alternative to other surgical approaches. Achieving gross-total resection with minimal complications is feasible with EES and is comparable, if not superior in some cases, to traditional means of resection. Ideally, a randomized controlled trial might be implemented in the future to further elucidate the effectiveness of EES for resection of craniopharyngiomas.

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Membrane Structures Between Craniopharyngioma and the Third Ventricle Floor Based on the QST Classification and Its Significance: A Pathological Study

Journal of Neuropathology & Experimental Neurology ◽

10.1093/jnen/nlaa087 ◽

2020 ◽

Vol 79 (9) ◽

pp. 966-974

Author(s):

Songtao Qi ◽

Yi Liu ◽

Chaohu Wang ◽

Jun Fan ◽

Jun Pan ◽

...

Keyword(s):

Third Ventricle ◽

En Bloc Resection ◽

Bloc Resection ◽

Arachnoid Membrane ◽

Membrane Structures ◽

Pia Mater ◽

En Bloc ◽

The Third ◽

Ependymal Layer ◽

Third Ventricle Floor

Abstract The aim of this study was to clarify the relationship between craniopharyngiomas (CP) and the third ventricle floor by analyzing the membranes between them. Eight fetal specimens were first examined by hematoxylin and eosin and immunofluorescence staining to determine optimal markers for identifying membrane structures in the sellar region. Then, 17 CP with third ventricle floor involvement that had been removed by total en bloc resection through a transsphenoidal approach were examined. We found that the dura mater, arachnoid membrane, and pia mater could be seen to separate type Q tumors from the third ventricle floor. The arachnoid membrane and pia mater could be seen between type S tumors and the third ventricle floor. Pia mater could be seen between type T tumors and the third ventricle floor; however, at the origin point of the tumor, pia mater could be loosened or replaced by the tumor. Although some type T tumors compressed the third ventricle, the ependymal layer remained intact. Based on these embryonic and pathological data, we suggest that CP are nonneuroepithelial, epi-pia mater, and epi-third ventricle tumors.

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Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients

Journal of Neurosurgery ◽

10.3171/2013.6.jns122259 ◽

2013 ◽

Vol 119 (5) ◽

pp. 1194-1207 ◽

Cited By ~ 108

Author(s):

Maria Koutourousiou ◽

Paul A. Gardner ◽

Juan C. Fernandez-Miranda ◽

Elizabeth C. Tyler-Kabara ◽

Eric W. Wang ◽

...

Keyword(s):

Radiation Therapy ◽

Pituitary Function ◽

Pituitary Insufficiency ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Total Resection ◽

Endoscopic Endonasal ◽

Repeat Surgery ◽

Visual Deterioration ◽

The Mean

Object The proximity of craniopharyngiomas to vital neurovascular structures and their high recurrence rates make them one of the most challenging and controversial management dilemmas in neurosurgery. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for both pediatric and adult craniopharyngiomas. The object of the present study was to present the results of EES and analyze outcome in both the pediatric and the adult age groups. Methods The authors retrospectively reviewed the records of patients with craniopharyngioma who had undergone EES in the period from June 1999 to April 2011. Results Sixty-four patients, 47 adults and 17 children, were eligible for this study. Forty-seven patients had presented with primary craniopharyngiomas and 17 with recurrent tumors. The mean age in the adult group was 51 years (range 28–82 years); in the pediatric group, 9 years (range 4–18 years). Overall, the gross-total resection rate was 37.5% (24 patients); near-total resection (> 95% of tumor removed) was 34.4% (22 patients); subtotal resection (≥ 80% of tumor removed) 21.9% (14 patients); and partial resection (< 80% of tumor removed) 6.2% (4 patients). In 9 patients, EES had been combined with radiation therapy (with radiosurgery in 6 cases) as the initial treatment. Among the 40 patients (62.5%) who had presented with pituitary insufficiency, pituitary function remained unchanged in 19 (47.5%), improved or normalized in 8 (20%), and worsened in 13 (32.5%). In the 24 patients who had presented with normal pituitary function, new pituitary deficit occurred in 14 (58.3%). Nineteen patients (29.7%) suffered from diabetes insipidus at presentation, and the condition developed in 21 patients (46.7%) after treatment. Forty-four patients (68.8%) had presented with impaired vision. In 38 (86.4%) of them, vision improved or even normalized after surgery; in 5, it remained unchanged; and in 1, it temporarily worsened. One patient without preoperative visual problems showed temporary visual deterioration after treatment. Permanent visual deterioration occurred in no one after surgery. The mean follow-up was 38 months (range 1–135 months). Tumor recurrence after EES was discovered in 22 patients (34.4%) and was treated with repeat surgery (6 patients), radiosurgery (1 patient), combined repeat surgery and radiation therapy (8 patients), interferon (1 patient), or observation (6 patients). Surgical complications included 15 cases (23.4%) with CSF leakage that was treated with surgical reexploration (13 patients) and/or lumbar drain placement (9 patients). This leak rate was decreased to 10.6% in recent years after the introduction of the vascularized nasoseptal flap. Five cases (7.8%) of meningitis were found and treated with antibiotics without further complications. Postoperative hydrocephalus occurred in 7 patients (12.7%) and was treated with ventriculoperitoneal shunt placement. Five patients experienced transient cranial nerve palsies. There was no operative mortality. Conclusions With the goal of gross-total or maximum possible safe resection, EES can be used for the treatment of every craniopharyngioma, regardless of its location, size, and extension (excluding purely intraventricular tumors), and can provide acceptable results comparable to those for traditional craniotomies. Endoscopic endonasal surgery is not limited to adults and actually shows higher resection rates in the pediatric population.

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