Abstract
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.
Highlights
Tumors located in the third ventricle behind the chiasma, such as craniopharyngiomas, are technically challenging due to their proximity to vital neurovascular structures including the hypothalamus, optic apparatus and anterior cerebral artery (ACA) complex
trans-lamina terminalis approach (TLTA) was used alone in 4 patients (Figure 2) while the trans-chiasm-pituitary corridor (TCPC) was combined with TLTA in 7 patients (Figure 3)
In a patient with an infra-NCL tumor of over 20%, only TLTA was used as the surgical strategy to achieve partial resection, followed by radiotherapy and chemotherapy; in this case, the frozen histological report indicated a germinal cell tumor (GCT) (Case 3)
Summary
Tumors located in the third ventricle behind the chiasma, such as craniopharyngiomas, are technically challenging due to their proximity to vital neurovascular structures including the hypothalamus, optic apparatus and anterior cerebral artery (ACA) complex. Access to these tumors is very difficult due to their deep location. Seo [9] reported a series of 82 cases of tumors involving the third ventricle resected by EEA. Most of these cases were treated via the infrachiasm corridor or chiasm-pituitary corridor. The surgical technique notes and outcomes of TLTA are discussed as well as its advantages and disadvantages
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