Abstract
BackgroundLarge intraventricular tumors (IVTs) impose technical and surgical challenges, due to their enormous sizes, mass effect, vast extensions, and vascularity.ObjectiveThe authors aim at presenting their results, clinical outcomes, and the surgical strategies in the management of large IVTs through transcortical approaches.MethodsA prospective trial was conducted at the Main Hospital of Alexandria University, Egypt, between August 2018 and October 2020 on 20 patients harboring IVTs larger than 5 cm or bilaterally represented. The variables evaluated included the extent of resection, postoperative neurological deficits, blood loss, surgical approaches, intraoperative challenges, complications, adjuvant therapies, Glasgow Outcome Scale, hydrocephalus, and cerebrospinal fluid (CSF) diversion.ResultsThe study included 20 cases (9 males and 11 females). Mean age at diagnosis was 16.1 years (range 1–45). Mean follow-up was 12 months (range 9–26). Primary tumor locations were ventricular body, atrium, temporal horn, and frontal horn in 11, 5, 3, and 1 cases, respectively. Main pathologies were central neurocytomas (7 patients/35%), ependymomas (3 patients/15%), and subependymal giant cell astrocytoma (SEGA) (3 patients/15%). Excision was gross total (n = 19) and near-total (n = 1). Significant intraoperative bleeding (n = 6). Postoperative minor intraventricular hemorrhage (n = 6), subdural collections (n = 8), hydrocephalus (n = 9), memory affection (n = 4), and motor deficits (n = 4). Postoperative Glasgow Outcome Scale of 5/5 (n = 20), no mortalities were recorded. preoperative seizures (n = 7), new onset postoperative seizures (n = 2).ConclusionSurgical approaches to large tumors of the lateral ventricles should be tailored to the variability of tumor locations, dimensions, extensions, and the individual morbid anatomy, in addition to the surgeon’s experience and preferences. Trans-cortical approaches can provide safe surgical corridors to tackle these challenging subtypes of IVTs with good clinical outcomes, tumor resectability rates, and seizure control.
Highlights
Shaw’s report in 1854 was one of the earliest reports on intraventricular tumors (IVTs) in the history of neurosurgery [1]
Tumors of the lateral ventricle constitute about 0.7 to 3% of all brain tumors and have a high predilection towards pediatric population [2,3,4,5,6]. These tumors are considered primarily IVTs if they arise from the ventricular lining and are considered secondarily intraventricular if they arise from the brain parenchyma outside the ventricles, but express exophytic extension of more than two-thirds of their masses inside the cavity of the lateral ventricles
A prospective trial was conducted at the Main Hospital of Alexandria University of Egypt between August 2018 and October 2020, and included 20 consecutive patients with IVTs which had dimensions greater than 5 cm or had bilateral ventricular extension or representation, and were operated through transcortical approaches
Summary
Shaw’s report in 1854 was one of the earliest reports on intraventricular tumors (IVTs) in the history of neurosurgery [1]. Tumors of the lateral ventricle constitute about 0.7 to 3% of all brain tumors and have a high predilection towards pediatric population [2,3,4,5,6]. These tumors are considered primarily IVTs if they arise from the ventricular lining and are considered secondarily intraventricular if they arise from the brain parenchyma outside the ventricles, but express exophytic extension of more than two-thirds of their masses inside the cavity of the lateral ventricles. Large intraventricular tumors (IVTs) impose technical and surgical challenges, due to their enormous sizes, mass effect, vast extensions, and vascularity
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