Abstract
When deciding on a surgical route to reach subcortical brain tumors and colloid cysts, many surgeons advocate the use of transcallosal, transsulcal, or skull base approaches over transcortical approaches due to a high reported incidence of postoperative seizures. We have retrospectively analyzed all patients operated upon by a senior neurosurgeon (Ricardo J. Komotar) who undertook transcortical approaches for the resection of subcortical brain tumors and colloid cysts. We have also performed a comprehensive review of the literature to estimate postoperative seizure risk after transcortical approaches for the resection of deep tumors and colloid cysts. Of 27 patients who underwent transcortical approaches for the resection of subcortical brain tumors and colloid cysts, zero had postoperative seizures. A comprehensive review of the literature shows an 8.3% postoperative risk of seizures after the transcortical approach. Our institution has never experienced a postoperative seizure following the transcortical approach for the resection of deep tumors and colloid cysts. For this reason, we advocate selecting a surgical approach that obtains adequate lesion exposure and minimizes the violation and retraction of eloquent cortex, venous structures, and white matter tracts, rather than on presumed postoperative seizure risk.
Highlights
The resection of deep-seated intraventricular and subcortical brain tumors is a difficult task, as complete resection requires the surgeon to develop a corridor that will minimize eloquent brain compromise and the retraction of parenchyma
The transcortical approach for the removal of such tumors was initially preferred by surgeons because it offers a wide microsurgical working space and flexibility, as seen in the resection of lateral ventricular tumors [1]
For third ventricular colloid cyst resections, the greatest advantage of the transcallosal approach is the avoidance of a cortical incision and the ability to provide natural planes for dissection to the anterior portion of the third ventricle
Summary
The resection of deep-seated intraventricular and subcortical brain tumors is a difficult task, as complete resection requires the surgeon to develop a corridor that will minimize eloquent brain compromise and the retraction of parenchyma. In order to avoid post-operative complications, many surgeons favor the transcallosal and skull-based approaches over the transcortical approaches due to a reportedly lower seizure rate. How to cite this article Eichberg D G, Sedighim S, Buttrick S S, et al (January 26, 2018) Postoperative Seizure Rate After Transcortical Resection of Subcortical Brain Tumors and Colloid Cysts: A Single Surgeon’s Experience. For third ventricular colloid cyst resections, the greatest advantage of the transcallosal approach is the avoidance of a cortical incision and the ability to provide natural planes for dissection to the anterior portion of the third ventricle. Endoscopic approaches have their drawbacks, as they require a steep learning curve to master and may be associated with greater residual lesion and recurrence rates [9,10]
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