Expanded Transsphenoidal Trans-Lamina Terminalis Approach to Tumors Extending Into the Third Ventricle: Technique Notes and a Single Institute Experience

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.

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

Operative Neurosurgery ◽

10.1093/ons/opy164 ◽

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.

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Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy

Journal of Neurosurgery ◽

10.3171/jns.1989.70.4.0525 ◽

1989 ◽

Vol 70 (4) ◽

pp. 525-529 ◽

Cited By ~ 55

Author(s):

Chad D. Abernathey ◽

Dudley H. Davis ◽

Patrick J. Kelly

Keyword(s):

Third Ventricle ◽

Total Removal ◽

Total Resection ◽

Content Type ◽

The Third ◽

Cyst Aspiration ◽

Colloid Cysts ◽

Mass Lesions ◽

Fine Print

✓ The therapeutic strategies employed in the management of anterior third-ventricular mass lesions remain controversial. Resection by conventional craniotomy, whether via a transcallosal or transcortical approach, carries well-known risks and limitations. Alternatively, in this region traditional stereotaxy has been relegated to use with biopsy only or cyst aspiration procedures. Combining aspects of both conventional and stereotaxic techniques has allowed total removal of 12 colloid cysts in six women and six men ranging in age from 25 to 71 years. No mortality and minimal morbidity have been associated with the procedures. There has been no evidence of recurrence in an average follow-up period of 19 months. By coupling the benefits of stereotaxic precision and localization to the microsurgical management of colloid cysts, several rewards have been realized: 1) only a limited cortical dissection is needed; 2) the hazards of callosal or forniceal injury can be avoided; 3) the lesion is easily localized regardless of ventricular size; 4) hemostasis can be readily achieved with bipolar cautery or defocused laser power; and 5) most importantly, a total resection is possible with little risk to the patient. Stereotaxic microsurgical laser craniotomy provides a new option for the management of colloid cysts and other anterior third-ventricular lesions.

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Cavernous Malformations in and Around the Third Ventricle: Indications, Approaches, and Outcomes

Operative Neurosurgery ◽

10.1093/ons/opz294 ◽

2019 ◽

Vol 18 (6) ◽

pp. 736-746

Author(s):

M Neil Woodall ◽

Joshua S Catapano ◽

Michael T Lawton ◽

Robert F Spetzler

Keyword(s):

Third Ventricle ◽

Lateral Wall ◽

Clinical Results ◽

Extent Of Resection ◽

Subtotal Resection ◽

Total Resection ◽

Cavernous Malformations ◽

Presenting Symptoms ◽

The Third

Abstract BACKGROUND Cavernous malformations in structures in and around the third ventricle are a challenging conceptual and surgical problem. No consensus exists on the ideal approach to such lesions. OBJECTIVE To perform a retrospective review of our institutional database to identify and evaluate approaches used to treat cavernous malformations located in and around the third ventricle. METHODS Information was extracted regarding lesion size and location, extent of resection, time to last follow-up, surgical approach, presenting symptoms, preoperative and postoperative neurological status, and specific approach-related morbidity. RESULTS All 39 neurosurgical operations (in 36 patients) were either an anterior interhemispheric (AIH) (44%, 17/39) or a supracerebellar infratentorial (SCIT) (56%, 22/39) approach. Gross-total resection was achieved in 23 of 39 procedures (59%), a near-total resection in 1 (3%), and subtotal resection in 15 (38%). For the 31 patients with at least 3 mo of follow-up, the mean modified Rankin Scale (mRS) score was 1.5. Of the 31 patients, 25 (81%) had an mRS score of 0 to 2, 4 had a mRS score of 3 (13%), and 1 each had a mRS score of 4 (3%) or 5 (3%). CONCLUSION Most approaches to cavernous malformations in and around the third ventricle treated at our institution have been either an AIH or a SCIT approach. The AIH approach was used for lesions involving the lateral wall of the third ventricle or the midline third ventricular floor, whereas the SCIT approach was used for lesions extending from the third ventricle into the dorsolateral midbrain, with acceptable clinical results.

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.1.peds10461 ◽

2011 ◽

Vol 7 (4) ◽

pp. 389-396 ◽

Cited By ~ 30

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.

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

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1624588 ◽

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.

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Aggressive surgery based on an anatomical subclassification of craniopharyngiomas

Neurosurgical FOCUS ◽

10.3171/2016.9.focus16211 ◽

2016 ◽

Vol 41 (6) ◽

pp. E10 ◽

Cited By ~ 22

Author(s):

Hiroki Morisako ◽

Takeo Goto ◽

Hiroyuki Goto ◽

Christian Aisse Bohoun ◽

Samantha Tamrakar ◽

...

Keyword(s):

Surgical Approach ◽

Third Ventricle ◽

Tumor Resection ◽

Radical Resection ◽

University Hospital ◽

Total Resection ◽

Formidable Challenge ◽

Orbitozygomatic Approach ◽

Microsurgical Resection

OBJECTIVE Craniopharyngiomas remain a particularly formidable challenge in the neurosurgical field. Because these lesions involve the hypothalamus and ophthalmological systems, their resection is associated with either higher rates of mortality and recurrence or a lower rate of radical resection. The authors report the outcomes of aggressive surgeries based on an anatomical subclassification of craniopharyngiomas. METHODS Clinical and ophthalmological examinations, imaging studies, endocrinological studies, neuropsychological function, and surgical complications in all patients who had undergone microsurgical resection for craniopharyngioma at Osaka City University hospital between January 2000 and December 2014 were retrospectively reviewed through the medical records. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor origin. The 4 possible groups included the intrasellar type, prechiasmatic type, retrochiasmatic type, and intra–third ventricle type. A multistage surgery was planned in some cases. RESULTS Seventy-two cases of craniopharyngioma were resected. Thirty-two patients (44.4%) had undergone previous surgical procedures at other institutions. Thirty-five cases (48.6%) were classified as retrochiasmatic, 19 (26.4%) as prechiasmatic, 12 (16.7%) as intra–third ventricle, and 6 (8.3%) as intrasellar. In 26 cases (36.1%), multistage surgery was required to complete the radical resection. Overall, 41 cases involved an orbitozygomatic approach; 21, a transpetrosal approach; 21, an interhemispheric approach; and 14, a transsphenoidal approach. In 3 cases, other approaches were applied. Gross-total resection was achieved in 43 patients (59.7%), near-total resection in 28 (38.9%), and partial resection in only 1 patient (1.4%). The mean follow-up period after resection was 4.7 years. Tumor recurrence or regrowth occurred in 15 (20.8%) of the 72 patients, with 14 of the 15 cases successfully controlled after additional resections and stereotactic radiosurgery. However, 1 patient died of uncontrollable tumor progression, and 2 patients died of unrelated diseases during the follow-up. Overall, disease in 69 (95.8%) of 72 patients was well controlled at the last follow-up. CONCLUSIONS Aggressive tumor resection is the authors' treatment policy for craniopharyngioma. Using an anatomical subclassification of craniopharyngioma to choose the most appropriate surgical approach is helpful in achieving that goal of aggressive resection.

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Clinical features and operative technique of transinfundibular craniopharyngioma

Journal of Neurosurgery ◽

10.3171/2019.3.jns181953 ◽

2020 ◽

Vol 133 (1) ◽

pp. 119-128 ◽

Cited By ~ 2

Author(s):

Bin Tang ◽

ShenHao Xie ◽

GuanLin Huang ◽

ZhiGang Wang ◽

Le Yang ◽

...

Keyword(s):

Clinical Features ◽

Operative Technique ◽

Third Ventricle ◽

Radical Resection ◽

The Third ◽

Expanded Endonasal Approach ◽

Sequencing Studies ◽

Characteristic Features ◽

Mri Study ◽

Adamantinomatous Craniopharyngioma

OBJECTIVETransinfundibular craniopharyngioma (TC) is one of the 4 subtypes of suprasellar craniopharyngioma. In this study, the authors analyzed the clinical features of and operative technique for TC.METHODSA total of 95 consecutive cases of suprasellar craniopharyngioma that had been resected via the endoscopic expanded endonasal approach were retrospectively reviewed. Patients were divided into 2 groups: 34 in the TC group and 61 in the nontransinfundibular craniopharyngioma (NC) group. Clinical and radiographic features, intraoperative findings, histopathological and genetic findings, and surgical outcomes were analyzed and compared between groups.RESULTSCompared with NC, TC was mostly seen in adult patients (97.1%); it was rare in children (2.9%). Clinical presentations tended toward headache, hydrocephalus, and diabetes insipidus. The relatively smaller volume, midline location (consistent with the stalk position), unidentifiable stalk, no shift of the third ventricle, and greater likelihood to involve the third ventricle and cause hydrocephalus were the characteristic features of TC in the preoperative MRI study. According to the degree of vertical extension of the tumor, the 34 TCs could be classified into 3 subtypes: type 1, entity was limited to stalk (n = 2, 5.9%); type 2, tumor extended up to the third ventricle (type 2a) or down to the subdiaphragmatic cavity (type 2b) (n = 23, 67.6%); and type 3, tumor extended in both directions (n = 9, 26.5%). For TC resection, the chiasm–pituitary corridor, lamina terminalis corridor, and pituitary corridor could be used separately or jointly. Most of the TCs originated from the infundibulum–tuber cinereum, grew within and along the long axis of the infundibulum, and the pituitary stalk was not usually preserved in TCs (20.6%), whereas the rate of preservation was higher (80.3%) in NCs. Bilateral hypothalamic injury was found in nearly all TCs if radical resection was performed, whereas the relationship between NCs and hypothalamus was either compression (32.8%) or unilateral invasion (67.2%). Meanwhile, the postoperative endocrine and neuropsychological function outcomes in patients with TC were worse than in patients with NC. The genetic analysis with whole-exome sequencing studies showed no differential mutations of CTNNB1 (β-catenin) and BRAF (V600E) between TC and NC subtypes, but there was a difference between adamantinomatous craniopharyngioma and papillary craniopharyngioma.CONCLUSIONSTC is a special subtype of suprasellar craniopharyngioma, which is remarkably different from NC. Identification of this type of tumor preoperatively is essential for the planning of appropriate surgical approach and degree of excision.

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Definite total radical resection in treatment of patients, suffering low-differentiated cancer of the bladder

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.11-12.76 ◽

2020 ◽

Vol 87 (11-12) ◽

pp. 76-79

Author(s):

P. G. Yakovlev

Keyword(s):

Radical Resection ◽

Average Period ◽

Total Resection ◽

Primary Radical ◽

Kaplan Meier ◽

Salvage Resection ◽

Cancer Of The Bladder ◽

The Difference ◽

Better Than

Objective. To determine the operative volume of surgical treatment in total radical resection of the bladder in autonomous regime and to estimate the survival indices in patients with low-differentiated cancer of the bladder depending on time of conduction of radical total resection of the bladder. Materials and methods. Retrospectively 522 histories of the diseases were analyzed in the patients with diagnosis of low-differentiated cancer of the bladder, including 190, in whom radical total resection of the bladder was performed in 1998 - 2016 yrs period. The survival indices were determined. Using Kaplan-Meier method, comparative analysis of the survival indices in patients was done, to whom radical total resection or salvage resection of the bladder performed. Results. Total radical resection of the bladder in autonomous regime was done in 24.7% patients with low-differentiated cancer of the bladder or in 67.9% patients, to whom total resection of the bladder was performed. The indices of total 3-, 5- and 10-yr survival of the patients have constituted 96, 93 and 45%, accordingly. The survival indices in the patients after organ-preserving treatment and further salvage total resection of the bladder for locally progression of cancer were better, than in the patients, to whom the treatment consisted of primary radical total resection of the bladder, but the difference have appeared statistically nonsignificant (p=0.286). Average period between conduction of organ-preserving treatment and salvage total resection of the bladder have constituted 34 mo. Conclusion. Radical total resection of the bladder in autonomous regime constitutes the extended method of treatment of muscularly-invaded low-differentiated cancer of the bladder (performed in 24.7% of all the patients) and guarantees satisfactory late follow-up results while primary or postponed performance.

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Purely Endoscopic Resection of Colloid Cysts

Operative Neurosurgery ◽

10.1227/01.neu.0000317373.00018.6f ◽

2008 ◽

Vol 62 (suppl_1) ◽

pp. ONS51-ONS56 ◽

Cited By ~ 23

Author(s):

Jeremy D.W. Greenlee ◽

Charles Teo ◽

Ali Ghahreman ◽

Bernard Kwok

Keyword(s):

Endoscopic Resection ◽

Third Ventricle ◽

Colloid Cyst ◽

Foramen Of Monro ◽

The Third ◽

Colloid Cysts ◽

Study Support

Abstract Objective: To further assess the safety and long-term efficacy of endoscopic resection of colloid cysts of the third ventricle. Methods: A retrospective review of a series of 35 consecutive patients (18 male, 17 female) with colloid cysts treated by endoscopic surgery was undertaken. Results: The mean patient age was 32.4 years (range, 11–54 yr). Headache was the most common presenting symptom (22 patients). The average tumor size was 18 mm (range, 3–50 mm). The endoscopic technique could not be completed in six patients, necessitating conversion to an open craniotomy and a transcortical approach to the colloid cyst. All patients had histologically confirmed colloid cysts of the third ventricle, and complete resection of the lesion was confirmed macroscopically and radiologically in all patients. There were no deaths. Two patients developed aseptic meningitis without any permanent sequelae. One patient developed unilateral hydrocephalus attributable to obstruction of the foramen of Monro, which was treated with endoscopic septum pellucidotomy. The median follow-up period was 88 months (range, 10–132 mo). There was one asymptomatic radiological recurrence. No seizures occurred after surgery. Conclusion: The results of this study support the role of endoscopic resection in the treatment of patients with colloid cysts as a safe and effective modality. In some cases, conversion to an open procedure may be required. Additional follow-up will be required to continue to address the duration of lesion-free survival.

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