A case of a cerebral cavernous malformation of the third ventricle that caused the syndrome of inappropriate secretion of antidiuretic hormone

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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A large cavernous malformation of the third ventricle floor: A case report

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2015.08.004 ◽

2015 ◽

Vol 49 (6) ◽

pp. 446-450 ◽

Cited By ~ 2

Author(s):

Hiroaki Nagashima ◽

Kazuhiro Tanaka ◽

Takashi Sasayama ◽

Yusuke Okamura ◽

Masaaki Taniguchi ◽

...

Keyword(s):

Case Report ◽

Cavernous Malformation ◽

Third Ventricle ◽

The Third ◽

Third Ventricle Floor

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

Operative Neurosurgery ◽

10.1093/ons/opz260 ◽

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.

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The anterior interhemispheric approach to a third ventricular cavernous malformation

Neurosurgical FOCUS ◽

10.3171/2016.1.focusvid.15461 ◽

2016 ◽

Vol 40 (videosuppl1) ◽

pp. 1

Author(s):

Nikolay L. Martirosyan ◽

M. Yashar S. Kalani ◽

Peter Nakaji ◽

Robert F. Spetzler

Keyword(s):

Frontal Lobe ◽

Surgical Resection ◽

Cavernous Malformation ◽

Third Ventricle ◽

Patient Positioning ◽

Optimal Location ◽

The Third ◽

Link Type ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach

The anterior interhemispheric approach is a workhorse for treatment of lesions in the third ventricle. In this case, we demonstrate the utility of this approach for resecting a complex third ventricular cavernous malformation. We discuss patient positioning, optimal location of the craniotomy, and surgical resection techniques for safe removal of these lesions. We also demonstrate the importance of gravity retraction using the falx to prevent injury to the dominant frontal lobe.The video can be found here: https://youtu.be/38woc28er7M.

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A Case of Neurosarcoidosis-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone Diagnosed with Neuroendoscopy

Case Reports in Medicine ◽

10.1155/2018/9496149 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Shiko Gen ◽

Akio Ogawa ◽

Koji Kanai ◽

Kanako Nobe ◽

Naofumi Ikeda ◽

...

Keyword(s):

Antidiuretic Hormone ◽

Third Ventricle ◽

Detailed Examination ◽

Cerebral Aqueduct ◽

Resonance Imaging ◽

Impaired Consciousness ◽

Inappropriate Secretion ◽

Nodular Lesions ◽

Magnetic Resonance Imaging Mri ◽

Neuroendoscopic Biopsy

We treated a patient with neurosarcoidosis, which caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), in whom diagnosis was performed using neuroendoscopy. The patient was a 56-year-old female who was hospitalized for hyponatremia and diagnosed with SIADH based on a detailed examination. During the course, she developed impaired consciousness due to acute hydrocephalus, which improved after ventricular drainage. Head magnetic resonance imaging (MRI) confirmed nodular lesions at the floor of the third ventricle and the cerebral aqueduct. Neuroendoscopic biopsy led to the diagnosis of neurosarcoidosis. Her hyponatremia improved after steroid therapy. Neurosarcoidosis can cause SIADH, and complication of hydrocephalus may lead to a poor prognosis. Neuroendoscopy appears to be effective for the diagnosis of neurosarcoidosis with hydrocephalus and helps in deciding the treatment modality.

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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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Ependymoma mimicking cavernous malformation of the third ventricle

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i4.903 ◽

2018 ◽

Vol 20 (4) ◽

pp. 442-444

Author(s):

Raphael Vicente Alves ◽

Emerson Magno F. de Andrade ◽

Mariano Ebran Fiore ◽

Airton Batista De Araújo Júnior ◽

Antônio Carlos Montanaro

Keyword(s):

Differential Diagnosis ◽

Rare Case ◽

Cavernous Malformation ◽

Third Ventricle ◽

Initial Diagnosis ◽

Case Description ◽

The Third ◽

Microsurgical Resection ◽

Rare Diagnosis

Introduction: Misdiagnosis of third ventricle lesions is not that rare. Case Description: The authors report on a patient who presented with a third ventricle lesion that neuroimaging appearance led to an initial diagnosis of cavernous malformation. A transcallosal transchoroidal approach was performed and complete microsurgical resection of the tumor was done. Histopathological and immunohistochemistry examination features a rare diagnosis of ependymoma in the third ventricle. Conclusion: Ependymomas should not be omitted from the differential diagnosis of tumors of third ventricle despite this place to be an unusual region for these lesions and they are rarely described.

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Transcallosal approach for third ventriculostomy and removal of midbrain cavernous malformation

Neurosurgical FOCUS ◽

10.3171/2013.v1.focus12348 ◽

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.

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