Transcallosal-interfornix approach to remove the tumors of the third ventricle and pineal region

Abstract

Objective To evaluate the efficacy of microsurgical resection of the pineal region tumors of the third ventricle through trans-corpus-callosum approach.Methods From January 2006 to June 2008, sixteen pineal region tumors of the third ventricle were resected through trans-corpus-callosum approach.In sixteen cases, two hypothalamic astroeytoma eases received ventricle shunt before operations;four germ cell tumors and one hypothalamic astrocytoma cases received end-plate-ostomy after operations.Of Sixteen eases, there were 4 astrocytomas,2 ependymomas, 2 central nervous system tumors,1 teratoma,1 cerebral cysticercosis, 6 pineal region tumors(including 4 germ cell tumor, 1 teratoma and 1 dermoid cyst). Results Of 16 microsurgical resections, 9 achieved total resection, 4 subtotal resection, 3 major resection (tumors in third ventricle: 7 achieved total resection, 2 subtotal resection,1 major resection;tumors in pineal region: 2 achieved total resection, 2 subtotal resection, 2 major resection). There was no postoperative coma or death.A postoperative hematoma in ventricle was found in one case with central nervous system tumor and the hematoma was removed.After operation,3 patients could not watch upwards,4 had the last obstacle to memory,1 had mutism. All patients were followed up from 3 months to 2 years.One case of recurrence was found in a astrocytoma patients whose tumor was subtotally removed and without postoperative radiotherapy and chemotherapy.One recurrence of astrocytoma was found and the second operation was performed. Of 16 cases, 14 cases lived normal life. Conclusions The approach of trans-corpus-callosum for microsurgical resection of pineal region tumors of the third ventricle, passing through the transparent space of embryonic tissue residue into the third ventricle, is a good operative approach with very little damage to normal brain tissue and directive vision to tumor. It could increase the total/subtotal resection rate and reduce post-operative complications. Key words: Brain tumor; Third ventricle; Pineal region; Callosum; Fornix