Frontal Transcortical Approach Research Articles

Tumors of the lateral and third ventricles of the brain. Possibilities of endoscopic transventricular surgery. Prospects and prognosis

Tumors of the lateral and third ventricles of the brain are uncommon in the general population. Taking into account possible disability, expected duration and quality of life of the patient in the postoperative period, radical removal of these tumors, especially invasive ones, are debatable. Purpose: to determine the possibilities of endoscopic transventricular surgery for tumors of the lateral and third ventricles of the brain. Materials and methods. Between 2015 and 2021, 61 patients with lateral and third ventricle tumors were treated, 9 of which were primary and 52 were invasive.All patients had a preoperative Karnofsky Performance scale score ≥70 points. Preoperative neurological status: non-focal neurological symptoms were observed in all patients, central significant hemiparesis (up to 2 points) - in 5, cognitive-mnestic disorders - in 31, opto-chiasmatic syndrome - in 2. Obstructive hydrocephalus was diagnosed in all patients. All patients underwent full-endoscopic removal by frontal transcortical transventricular approach. Results. Total tumor resection (within healthy tissues) was performed in 34 patients, subtotal (up to 90%) – in 17, partial – in 10 patients. The postoperative condition according to Karnofsky Performance scale in all patients was ≥70 points. Hemiplegia was registered in 8 (13.1%) patients (sustained deficiency, hemiparesis (up to 3 points) - in 2 (1.22%) patients), hemianopsia - in 4 (6.5%) patients, short-term memory impairment - in 9 ( 14.75%), regression was observed 2–4 weeks after surgery. Thirty-seven (60.7%) patients died. The remaining patients (39.3%) are under observation. Median survival was 33 weeks (95% confidence interval (CI) 28–40 weeks). Postoperative survival in patients with glioblastoma was 15 weeks, median survival was 9.5 weeks (95% CI, 4–15 weeks). Of the patients with anaplastic astrocytoma, 13 (92.9%) patients died within 38 weeks after surgery, the median survival was 18 weeks (95% CI, 14.5–29.0 weeks), 1 (7.1%) patient was under observation. Patients with anaplastic oligodendroglioma had a median survival of 34.5 weeks (95% CI - 28-40 weeks), 15 (65.2%) patients died within 40 weeks, 8 (34.8%) patients are under observation. The difference between groups in survival was statistically significant (p<0.0001). Median survival in women was 34.5 weeks (95% CI, 29–40 weeks), in men, 28 weeks (95% CI, 18–39 weeks). There were 12 (42.9%) women and 12 (36.4%) men who survived for more than 60 weeks. No statistically significant difference was found between male and female survival rates (p=0.309). Conclusions. The ability of achieving the optimal resection volume of primary and invasive tumors of the third and lateral ventricles allows recommending the anterior endoscopic transcortical transventricular approach as an effective method of surgical treatment of these tumors. Radical endoscopic resection, as the first stage of combined treatment of patients with malignant tumors of the third and lateral ventricles, increases the patients’ life expectancy with a minimal risk of postoperative neurological complications, comparable to the life expectancy of patients with malignant tumors of supratentorial localization. To eliminate obstructive hydrocephalus and prevent the obstruction of CSF circulation in case of postoperative edema or continued growth in invasive tumors of the lateral and third ventricles, it is advisable to perform triventriculocisternostomy.

Postoperative complications in endoscopic frontal transcortical surgery of lateral and third ventricle tumours

Neurosurgical approaches to lesions of the lateral and the third ventricles are divided into two fundamentally different groups: transcortical neurosurgical approaches, including - endoscopic and interhemispheric transcallosal micro-neurosurgical approaches. Complications in surgery of lateral and third ventricle tumours are often associated with the specific approach technique and could be transient. We analyzed postoperative neurological complications and the approach criteria on MRI or CT scans in the postoperative period such as localization of corticotomy, distance from corticotomy to the coronal suture, “angle of attack” after the frontal transcortical approach to the lateral and third ventricle based on 54 cases and presume transient nature of specific to approach complications and approaches’ factors that have a role in postoperative mutism.

Postoperative complications in endoscopic frontal transcortical surgery of lateral and third ventricle tumours

Neurosurgical approaches to lesions of the lateral and the third ventricles are divided into two fundamentally different groups: transcortical neurosurgical approaches, including - endoscopic and interhemispheric transcallosal microneurosurgical approaches. Complications in surgery of lateral and third ventricle tumours are often associated with the specific approach technique and could be transient. We analyzed postoperative neurological complications and the approach criteria on MRI or CT scans in postoperative period such as localization of corticotomy, distance from corticotomy to coronal suture, “angle of attack” after the frontal transcortical approach to the lateral and third ventricle based on 54 cases and presume transient nature of specific to approach complications and approaches’ factors that have role in postoperative mutism.

Rigid endoscopic surgery of brainstem cavernous malformation on the cerebral aqueduct. Case report

Cavernous angiomas (malformations) of the brain occur in 0.5% of the population. Most of them are asymptomatic, but due to their anatomical features, namely escape of blood into surrounding tissues, significant neurological symptoms can occur. The deep location of cavernous angiomas in the area of cerebral aqueduct makes surgical intervention difficult. Microsurgical approaches are the gold standard in removal of cavernous angiomas, but they are associated with certain surgical risks in the formation of the surgical corridor. Cavernous malformations in the cerebral aqueduct are a rare subtype. Due to anatomical localization and concomitant obstructive hydrocephalus ІІІ and lateral ventricles, they can be removed by endoscopic frontal transcortical transventricular approach. A 59-year-old patient was diagnosed with cavernous angioma of the brainstem (in the area of cerebral aqueduct) with hemorrhage and the formation of obstructive hydrocephalus ІІІ and lateral ventricles. The operation was performed: removal of the cavernous angioma in the area of cerebral aqueduct by endoscopic frontal transcortical transventricular approach on the right. Additionally, a triventriculocisternostomy was performed. Osteoplastic trepanation with centering at the Kocher’s point in size of 4 × 4 cm and the formation of a free bone flap was performed. The dura mater is cut in an H-shape. Approach to the anterior horn of the right lateral ventricle was performed. An intracerebral retractor was inserted into the anterior horn of the right lateral ventricle. Transforaminal approach to the tuber cinereum was performed - a triventriculocisternostomy was performed. Transforaminal approach to the cerebral aqueduct was performed and the cavernous angioma of the brainstem was removed. In the postoperative period, the patient had a slight deterioration in short-term memory, which regressed 2 weeks after surgery, an increase in oculomotor disorders, in particular persistent diplopia due to moderate paresis of the left oculomotor nerve. Three months after the operation, magnetic resonance imaging of the brain with intravenous contrast enhancement was performed. There are no signs of cavernous angioma. After the operation of frontal transcortical transventricular removal of cavernous angioma in the area of cerebral aqueduct, the compression of the latter was eliminated. Occlusive hydrocephalus regressed, the size of the ventricles decreased. Endoscopic frontal transcortical transventricular approach allows reaching the area of cerebral aqueduct in a less traumatic and minimally invasive manner. This technique is effective due to the low risk of surgical approach complications.

Peculiarities of the third ventricle surgery in endoscopic frontal transcortical approach

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.

Cognitive function assessment and comparison on lateral ventricular tumors resection by the frontal transcortical approach and anterior transcallosal approach respectively in children.

Currently, there are few studies on cognitive impairment caused by neurosurgery, and there have been no studies on cognitive impairment after resection of lateral ventricular tumors in children. Previously, our research team has reported that the frontal transcortical approach can impair cognitive function. In this study, we explored which functions would be damaged by the transcallosal approach and compared the cognitive function changes caused by the two surgical approaches, so as to provide a theoretical basis for the selection of pre-operative surgical approaches. The authors prospectively collected pediatric patients with lateral ventricular tumors who had undergone surgical resection through the frontal transcortical approach and anterior transcallosal approach in Beijing Tiantan Hospital from November 2012 to May 2017. The inclusion criteria according to the Children Wechsler Scale requirements and clinical performance were formulated. Wechsler Intelligence Scale for Children®-fourth edition: Chinese version (WISC-IV) was adopted for general intelligence and cognitive function assessment in the study. In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the pre-operative period and 6-month follow-up in post-operation. A total of 30 patients were enrolled. Gross total resection was achieved in all patients, and no severe post-operative complications were observed. The frontal transcortical approach was applied in 19 patients, and the transcallosal approach was conducted for 11 patients. Compared with the pre-operative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV in post-operation. In patients accepting lateral ventricular tumors resection through the anterior transcallosal approach, the total IQ was declined to M = 84.82, SD = 8.072 from M = 93.27, SD = 6.635 within the 6-month convalescence. The data of working memory (t = - 2.990, p = 0.002) and total IQ (t = - 2.205, p = 0.028) pre- and post-operative showed statistical significance. But in the comparison of two surgical approaches, it was found that IQ had no statistical difference in WISC-IV tasks data. Previous studies suggest that the frontal transcortical approach impair perceptual reasoning, processing speed, and IQ, while this study indicates that the anterior transcallosal approach impairs patients' working memory and IQ. Both approaches make equal damage to IQ. Through comparing the two surgical approaches, it can be known that the anterior transcallosal approach cannot replace the frontal transcortical approach. The protection of cognitive function should be considered as one of the bases for neurosurgeons to select the operative approach before the operation. However, in an actual situation, the specific approach should be carefully selected by comprehensive consideration.

Cognitive performance change of pediatric patients after conducting frontal transcortical approach to treat lateral ventricular tumor.

Applying frontal transcortical approach to treat lateral ventricular tumor is one of the most common neurosurgical manipulations. The frontal transcortical approach generally passes through the middle frontal gyrus in which there is no major function involved in the traditional sense. However, current researches have suggested that the prefrontal cortex (PFC) plays a central role in the whole network of the brain cognitive frame. In addition, cognitive function is crucial in growing and developmental stages and essential for the educational achievement, especially for children. Based on this, the authors in this study analyzed cognitive performance change of pediatric patients who had accepted frontal transcortical operation in 1-year follow-up and discussed the possibility of higher cognitive functions of the damaged region. In this single-center study, 15 pediatric patients (median age at surgery, 9.21years old; range, 6.42-14.17years old) who had been treated with frontal transcortical approach for lateral ventricular tumors were selected as research objects. The cognitive function assessment was conducting by adopting the revised Wechsler Intelligence Scale for Children-fourth edition (WISC-IV). In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the preoperative period and 1-year follow-up after surgery. GTR was achieved in all patients, and all patients were in good condition after surgery. Compared to the preoperative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV after surgery, for example, the total IQ was declined to M=83.60, SD=9.500 from M=95.33, SD=13.844 within 1year convalescence. The data of perceptual reasoning (t=-2.392, p=0.016), processing speed (t=-2.121, p=0.033), and total IQ (t=-2.638, p=0.008) before and after surgery showed statistically significance. Furthermore, decreased functional connectivity and disconnected neural fasciculus were revealed by the size of activation regions in the resting-state fMRI and the reconstruction of three-dimensional images of white matter tracts in the DTI pre- and post-operative. The PFC was not regarded as a major functional area in the past, but the researches at present have shown that the interactions between PFC and other posterior brain regions serve as the basis of the higher cognitive functions. According to imaging manifestations and WISC-IV tasks in this paper, we found that the PFC injury caused by the frontal transcortical approach led to damaged brain structure and impaired the performance of cognitive function. On this basis, we detected that the perceptual reasoning and processing speed maybe have more extensive connections with the middle frontal gyrus.

An Elderly Patient with Pilocytic Astrocytoma Operated on 14 Years after Initial Detection:A Case Study

Pilocytic astrocytomas are found predominantly in the pediatric population and are extremely rare in elderly patients. We describe a case of pilocytic astrocytoma in an elderly patient who presented with the symptoms of an enlarged tumoral cyst. A 70-year-old woman was found to have an asymptomatic small solid tumor with a cystic component in the right frontal lobe at "Ningen Dock(medical checkup)of the Brain". She was hospitalized and underwent further examinations including cerebral angiography. At that time, she was opposed to undergoing an operation for tumor removal owing to lack of symptoms. Approximately fourteen years later, she presented with dizziness upon posture conversion and recent memory disturbance. Computed tomography scanning revealed an enlarged cyst in the frontal lobe and perifocal edematous changes. Gadolinium-enhanced magnetic resonance imaging partially revealed the solid tumor and cystic capsule. The solid tumor had not enlarged substantially. The cystic fluid was aspirated and the solid tumor was resected via a frontal transcortical approach. The histological diagnosis was pilocytic astrocytoma without malignant features. After surgery, the patient's symptoms improved and additional therapy was not provided. After a year of postoperative follow-up, the size of the cystic lesion has reduced, and no recurrence of the solid tumor has been observed.

Quantification of white matter fibre pathways disruption in frontal transcortical approach to the lateral ventricle or the interventricular foramen in diffusion tensor tractography.

Pathologies occupying the interventricular foramen (foramen of Monro - FM) or the anterior part of lateral ventricle (LV) are accessed by the transcortical or transcallosal route. As severing of rostral corpus callosum has been deemed inferior to cortical incision, the approaches through various points of frontal lobe have been developed. Superior (F1), middle (F2) frontal gyrus or occasionally superior frontal sulcus are used as an entry of neurosurgical corridor. In spite of the fact that every approach to LV or FM causes its characteristic irreversible damage to white matter, to date all of transcortical routes are regarded as equivalent. The current study compared the damage of main neural bundles between virtualtrans-F1 and trans-F2 corridors by means of diffusion tensor tractography method (DTT) in 11 magnetic resonance imaging (MRI) exams from clinical series (22 hemispheres, regardless of dominance). Corpus callosum, cingulum, subdivisions I and II of superior longitudinal fasciculus (SLF I and SLF II), corticoreticular as well as pyramidal tracts crossing both approaches were subjected to surgical violation. Both approaches served a similar total number of fibres (0.94 to 1.78 [× 103]).Trans-F1 route caused significantly greater damage of total white matter volume(F1: 8.26 vs. F2: 7.16 mL), percentage of SLF I fibres (F1: 78.6% vs. F2: 28.6%)and cingulum (F1: 49.4% vs. F2: 10.6%), whereas trans-F2 route interrupted morecorticoreticular fibres (F1: 4.5% vs. F2: 30.7%). Pyramidal tract (F1: 0.6% vs. F2:1.3%) and SLF II (F1: 15.9% vs. F2: 26.2%) were marginally more vulnerable incase of the access via middle frontal gyrus. Both approaches destroyed 7% of callosal fibres. Summarising the above DTT findings, trans-F2 route disrupted a greater number of fibres from eloquent neural bundles (SLF II, pyramidal and corticoreticular tracts), therefore is regarded as inferior to trans-F1 one. Due to lack of up-to-date guidelines with recommendations of the approaches to LV or FM, an individual preoperative planning based on DTT should precede a surgery.

Subependimoma del ventrículo lateral. A propósito de un caso

INTRODUCTION. Intracranial subependymomas are rare, slow-growing, noninvasive, benign tumors. They are most often located in the fourth ventricle. Most of these tumors are discovered incidentally during autopsy. Routine medical checkups using neuroimaging techniques have increased their diagnosis. Subependymomas may present with symptoms related to cerebrospinal fluid obstruction or mass effect. CASE REPORT. A 52-year-old man presented with severe headache and mental deterioration with memory disturbances and bradypsychia. Computed tomography and magnetic resonance imaging revealed a mass in the right lateral ventricle causing obstructive hydrocephalus. The tumour was totally removed through a right frontal transcortical approach. Histological examination showed a typical subependymoma. A complete neurological recovery was achieved after surgery. CONCLUSIONS. Subependymomas are rare low-grade glial neoplasm that commonly arise in the ventricular system. They have a low-proliferative potential but in these locations they can cause symptomatic hydrocephalus. Surgical removal of the mass and the restoration of the normal cerebrospinal fluid pathways constitute the optimal management strategy.

Frontal transcortical approach in 12 Central Neurocytomas

Central neurocytomas (CN) are rare intraventricular tumors with benign clinical behavior that typically affect young adults. Although a favorable prognosis is generally expected after adequate management, there is no general consensus on the standard of therapy. We evaluated the efficacy and safety of radical surgery for the management of CN. Between 1996 and 2010, 12 patients with CN (eight males and four females; range, 18 to 62years; mean age, 28.5years) were surgically treated in our institution. The initial goal of therapy was complete resection through a frontal transcortical approach, and repeat surgery was done in cases of residual or recurrent disease. The mean follow-up period was 51.2months (range, 14-149months). Complete resection was achieved in all patients either with primary (nine patients, 75%) or second-look surgery (three patients, 25%). No mortalities occurred and there were four surgery-related complications (two events of transient hemiparesis, one transient aphasia, and onepostoperative subdural hygroma). All patients were alive with normal activities of daily living at the last follow-up. Two patients (16.6%) experienced a single recurrence at 26 and 66months, one of whom underwent redo-surgery. For the management of CN, complete resection is feasible, effective, and safe. Repeat surgery may be a viable option in cases of residual or recurrent disease and the use of radiotherapy can be avoided in this young population.

Remote epidural haematoma and severe basal ganglia oedema complicating the removal of a central neurocytoma in the lateral ventricle: A case report and lessons learned

Tumours of the lateral ventricle are common in general neuosurgical practice with a reported incidence of 0.81–1.6% [1]. he majority of these lesions are benign or low grade and an be removed successfully through carefully planned surgical pproaches. However, even for experienced surgeons, the surgical emoval of these tumours remains a challenge and may occasionlly cause severe neurological morbidity or even death. In the resent report, we described a unique case of a lateral ventricular eurocytoma that simultaneously developed two rare but dreaded omplications in the form of a remote epidural haematoma and evere basal ganglia oedema following surgical removal of the umour using a frontal transcortical approach. The patient had an ventful clinical course, but a satisfactory outcome was achieved. he mechanism by which remote postoperative EDHs develops is nclear, but several hypotheses have been proposed. In our case, he loss of a substantial CSF volume during surgery, which caused sudden drop in intracranial pressure, may have played a signifiant role in the pathophysiological development of the remote EDH. he involvement of the thalamostriate vein during surgery and the

Craniotomy treatment for ventricular hemorrhage

Objective To investigate the techniques,effectiveness of interhemispheric transcorpus callosal approach with septostomy or frontal transcortical approach for the management of primary hypertensive ventricular hemorrhage.Methods Eighteen patients with primary ventricular hemorrhage or thalamicorcaudate hemorrhage complicated by ventricular hemorrhage received operation for removal of intraventricular blood clots by the interhemispheric,transcorpus callosal approach with septostomy or frontal transcortical approach.All patients received brain CT examination before and after surgery.The clinical outcomes were assessed 3 months after surgery by GOS.Results Good clinical outcomes ( GOS ≥4) were achieved in 50％ of patients.The overall mortality rate at 3 months postsurgery was 6％.Conclusions The interhemispheric transcorpus callosal approach with septostomy or frontal transcortical approach is safe and effective for direct removal of intraventricular blood clots for the treatment of supratentorial ventricular hemorrhage with obstructive hydrocephalus. Key words: Intraventricular hemorrhage; Craniotomy; Interhemisphere trancorpus callosal approach; Frontal transcortical approach

Spontaneous acute hemorrhage within a subependymoma of the lateral ventricle: successful emergent surgical removal through a frontal transcortical approach

Introduccion. Los subependimomas son neoplasias benignas que se desarrollan en estrecha relacion con el sistema ventricular y que excepcionalmente asocian fenomenos hemorragicos. Describimos el caso de un subependimoma localizado en el ventriculo lateral que presento una hemorragia intratumoral aguda de forma espontanea, como se evidencio en los estudios neurorradiologicos y patologicos realizados, incluyendo un analisis exhaustivo de los casos similares descritos en la literatura cientifica. Caso clinico. Se trata de un varon de 71 anos que recibia tratamiento anticoagulante, y que presento un cuadro brusco y progresivo de disminucion del nivel de conciencia. Los estudios de neuroimagen evidenciaron la presencia de una masa localizada en el ventriculo lateral izquierdo, con signos de hemorragia reciente en su seno, que producia hidrocefalia biventricular aguda. La lesion fue resecada en su totalidad de forma urgente mediante un abordaje frontal transcortical. El estudio patologico de la lesion demostro que se trataba de un subependimoma con focos hemorragicos. En el periodo postoperatorio, el paciente presento un deficit de memoria global, tanto anterograda como retrograda. Conclusiones. Los episodios de hemorragia espontanea aguda constituyen un fenomeno excepcional en el caso de los tumores de histologia benigna como los subependimomas, y pueden transformar un curso clinico asintomatico en una emergencia quirurgica debido al desarrollo de hidrocefalia aguda. La extirpacion completa de la lesion de forma urgente representa la opcion de manejo quirurgico mas apropiada, ya que permite un reestablecimiento inmediato de la circulacion de liquido cefalorraquideo y previene la aparicion de resangrado.

Giant intraventricular mass arising from the septum pellucidum

A 55-year-old male patient was admitted with complaints of headache for one month. The neurological examination was normal. MRI revealed an inhomogeneous lesion in the lateral ventricles, arising from the septum pellucidum. The mass was isointense with areas of hyperintensity on T1-weighted MRI, and it was heterogeneously hyperintense on T2-weighted MRI with minimal contrast enhancement (Fig. 1). There was evidence of intense blooming on gradient echo MRI (Fig. 2). A gross total surgical excision was performed by a right frontal transcortical approach. The patient had an uneventful postoperative course.

Spontaneous acute hemorrhage within a subependymoma of the lateral ventricle: successful emergent surgical removal through a frontal transcortical approach

INTRODUCTION. Subependymomas are benign neoplasms intimately related to the ventricular system which only exceptionally associate hemorrhagic events. We present neuroradiological and pathological evidences of intratumoral hemorrhage within a single case of subependymoma operated on at our institution. Additionally we analyze retrospectively the well-defined reports of similar cases published in the scientific literature. CASE REPORT. A 71-year-old man on anticoagulant therapy presented with abrupt and progressive deterioration of his level of consciousness. Emergent computed tomography and magnetic resonance imaging evidenced signs of acute bleeding within a mass located at the frontal horn of the left lateral ventricle, producing obstructive biventricular hydrocephalus. The lesion was immediately and completely removed through a left frontal transcortical approach. Pathological diagnosis was consistent with subependymoma displaying areas of microhemorrhage. After surgery the patient developed global anterograde and retrograde amnesia. CONCLUSIONS. A spontaneous hemorrhagic event within an asymptomatic lateral ventricle subependymoma can result in a surgical emergence as a consequence of sudden obstruction of cerebrospinal fluid pathways. Prompt and radical surgical removal of the mass, which allows a rapid resolution of hydrocephalus and prevents the risk of rebleeding, may constitute the safest management strategy.

Tuberous sclerosis combined with subependymal giant cell astrocytoma

Objective To describe the clinical features, diagnosis and treatment of subependymal giant ceil astrocytoma. Method Out of 17 TSC patients admitted to Tiantan Hospital from September 1996 to April 2006, 17 tumors out of 16 patients were removed surgically. 11 tumors were surgically resected through transcallosal approach, 6 through frontal transcortical approach. Follow-up ranged from 3 months to 123 months. Results 1 case died 2 years later without operation. Out of 17 pathologically confirmed SEGAs from 16 patients, 15 tumors were totally removed,2 tumors were subtotally removed. 1 case died 3 months after operation, excellent outcomes occurred in other 15 patients without long-term complications. It was necessary to insert a postoperative shunt in only 3 patients. There were no recurrences of 15 SEGAs that were totally removed after a mean follow-up of 41.2 months. Radiotherapy was proved ineffective. Conclusions Surgical removal is the only effective treatment of SEGA. Transcallosal approach and frontal transcortical approach are both effective. Key words: Tuberous sclerosis; Subependymal giant cell astrocytoma; Diagnosis; Surgery

Third ventricular chordoid meningioma in a child

Meningiomas are rare in children. Chordoid meningioma is a very rare variant, as only 16 cases in children have been reported. The authors report the first case of a chordoid meningioma in the third ventricle. A 12-year-old boy presented with headache, abnormal behaviors, and ataxia. Brain MR imaging revealed a 2-cm, well-enhanced mass in the third ventricle and hydrocephalus. Positron emission tomography with [18F]fluorodeoxyglucose showed that the mass was hypermetabolic. Gross-total removal of the mass was performed using a left frontal transcortical and transventricular approach. The mass originated from the left caudate head and was connected to the choroid plexus. A chordoid meningioma was diagnosed on the basis of the histological characteristics of the tumor, which was composed of cords and nests of eosinophilic vacuolated cells with an abundant myxoid matrix, similar to the features of a chordoma. A typical focal meningiomatous pattern was observed. The tumor cells were immunoreactive for vimentin and epithelial membrane antigen. The patient's headache and gait disturbance improved after the tumor was removed. The tumor showed no signs of recurrence during 12 months of follow-up.

Glioblastoma multiforme of the lateral ventricle: report of nine cases

Glioblastoma multiforme is the most common lethal primary central nervous system (CNS) tumour in adults and they are rarely seen as primary intraventricular tumours. We present nine cases with lateral ventricle glioblastoma multiforme treated in our department. Seven of the nine tumours were located at the body of the lateral ventricle, whereas the other tumours were arising from septum pellicidum. Five patients were operated through an anterior transcallosal approach and four patients were operated through frontal transcortical approach. Total tumour excision was achieved only in one patient. Median survival time was 18.8 months. Three patients were alive at the end of study, and received radiotherapy and chemotherapy. Our goal was the decompressive surgery for these tumours without harming eloquent structures. In our opinion, patient's life quality is critically important in the postoperative period for these mortal tumours with rapid progression.

Transcortical or transcallosal approach to ventricle-associated lesions: a clinical study on the prognostic role of surgical approach.

Most entities in and around the anterior two-thirds of the supratentorial ventricles can be reached via transcortical or transcallosal approach. This study examined the effect of surgical approach on the postoperative neurological outcome. Thirty-eight patients with intra- and periventricular supratentorial lesions were operated on by either frontal transcortical or anterior transcallosal approach. Postoperative diencephalic damage occurred in 22% of patients in the transcortical group and in 36% in the transcallosal group; transient mutism was virtually equivalent in the two groups. Postoperative epilepsy (26%) and subdural fluid collections (30%) occurred only in the transcortical group. The incidence of postoperative hemiparesis was higher in the transcallosal group. There was a high correlation between postoperative Glasgow Outcome Score of 5 and preoperative severity of neurological disease but no correlation between postoperative Glasgow Outcome Score of 5 and location of the lesion or between postoperative clinical course and surgical approach. Surgical outcome of ventricle-associated lesions depends mainly on the severity of preoperative symptoms and not on surgical approach. Additionally, the incidence of postoperative seizures and subdural fluid collections after transcortical surgery is high.