Immediate morbidity and mortality associated with transcallosal resection of tumors of the third ventricle

Abstract

Resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach represents a surgical challenge. It carries a risk of postoperative complications, due to the role of surrounding structures in control of eloquent functions. We reviewed the immediate morbidity and mortality associated with this approach. Between June 1993 and July 2007, 38 patients underwent resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach at The University of Texas M. D. Anderson Cancer Center. Their 30-day postoperative morbidity and mortality rates were retrospectively analyzed relative to clinical variables possibly affecting these rates. Complications were categorized as neurological, regional, and systemic and were subclassified as major or minor. The overall complication rate was 50%. Major complications occurred in 37% of patients; 34% suffered neurological complications (16% being major complications). Surgical mortality was 8%. Univariate analysis demonstrated that tumor hemorrhage ( p = 0.04), preoperative Karnofsky Performance Scale (KPS) score ( p = 0.04), tumor status (recurrent versus [ vs.] new or residual; p = 0.01), and cauterization of any of the bridging veins ( p = 0.04) were associated with the incidence of postoperative complications. Multivariate analysis showed that increased age at surgery ( p = 0.04), tumor status ( p = 0.03), preoperative KPS score ( p = 0.02), and the extent of tumor resection ( p = 0.05) correlated significantly with the incidence of postoperative complications. Resection of tumors of the third ventricle via the interhemispheric transcallosal approach is associated with significant postoperative morbidity. Preserving the venous structures is of paramount importance in minimizing major neurological complications. Our results have practical risk-predictive value and can serve as the foundation for subsequent outcome studies.