Abstract
Goal. To analyze the results of surgical treatment patients with the third ventricular pathology. Objective. To improve methods of transchoroidal dissection. To make enough space for surgery of the third ventricle by expanding the foramen of Monro. To reduce the risk of surgical treatment in the pathology at the posterior compartment of the third ventricle. Materials and methods. The results of treatment of 27 patients with tumors and colloid cysts to the third ventricle were analyzed. In all 27 patients endoscopic frontal transcortical approach was performed. In 24 cases of them extended anterior choroidal dissection was performed (transchoroidal and transforaminal approach); in 3 cases — transcortical transforaminal approach (without choroidal dissection). In all case there was fully endoscopic removal (100 %). Results. Gross total resection was achieved in 14 cases, subtotal resection — in 13 cases. Karnofsky Performance Scale in the postoperative period demonstrated ≥ 70 points in all patients. Complications occurred in 4 patients (14.8 %). No postoperative mortality was observed. Conclusions. 1. Transcortical transforaminal approach can be used for the pathology in the anterior compartment of the third ventricle. 2. Transcortical transchoroidal approach can be performed for the pathology, which localized or spread into the posterior part of the third ventricle. 3. Anterior transchoroidal dissection can be combined with transforaminal approaches if the ventricular hydrocephalus is not much expressed, foramen of Monro is not much enlarged to complete transforaminal procedure as well as when the tumor spreads to the posterior compartment of the third ventricle. 4. The number of complications related to the frontal transcortical transventricular approach in our series is 14.8 %, and they had transient nature and relapsed within a month postop; no postoperative mortality.
Highlights
Intermediate transcallosal or transcortical approaches are widely used to treat pathology of the ventricular system
Transcortical transforaminal approach can be used for the pathology in the anterior compartment of the third ventricle
Anterior transchoroidal dissection can be combined with transforaminal approaches if the ventricular hydrocephalus is not much expressed, foramen of Monro is not much enlarged to complete transforaminal proccedure as well as when the tumor spreads to the posterior compartment of the third ventricle
Summary
Intermediate transcallosal or transcortical approaches are widely used to treat pathology of the ventricular system. Each of these approaches has advantages and certain features, which are still under discussion [1, 2]. Its size and ventricular hydrocephalus, transcortical transforaminal or transcortical transchoroidal approach or their combination may be used [6,7,8]. The combination of them — extended transforaminal approach (transforaminal approach with anterior choroidal dissection) makes it possible to reduce postoperative complications, with adequate visualization of the pathology and an acceptable angle of “attack” upon the posterior third ventricle tumor. The region is deep seated and surrounded by critical structures that are injured, leading to potentially disastrous outcomes
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