Ganglioglioma of the Right Lateral Ventricle Approached with Neuronavigation and Intraoperative DTI. Case Report and Literature Review.

Abstract

BACKGROUND AND STUDY OBJECT: We describe the case of a young patient treated for a ganglioglioma of the right lateral ventricle. The ganglioma was approached via a temporal route using neuronavigation. Such lesions, if confined to the ventricular system and, especially, to the lateral ventricle, are unusual. A 22-year-old male was admitted because of headache and seizures. Magnetic resonance imaging (MRI) revealed a neoplasm in the temporal horn of the right lateral ventricle. A CT scan demonstrated calcifications. After preoperative planning, the patient was scheduled for neuronavigated operation. A small temporal craniotomy was performed. Once the dura was opened, we acquired a volumetric intraoperative MRI with diffusion tensor imaging (DTI). The optic tract was visualized again on intraoperative DTI and the volumetric MRI was used to update the navigational data. The temporal corticotomy between the inferior and the middle temporal gyrus was guided by neuronavigation, keeping the surgical corridor in distance to the optic tract until the tumor was reached. After tumor resection, we repeated intraoperative MRI with DTI, which confirmed complete tumor removal and the patency of the optic pathway. Our protocol allowed us to reach the lesion via a minimally invasive approach with near real-time control of the integrity of the optic tract during surgery. DTI was acquired preoperatively and during surgery, avoiding inaccuracy due to brain shift. Intraoperative MRI with DTI allows to treat such lesions via minimally invasive approaches and to reduce operative morbidity due to fiber tract damage.