Transcortical Transventricular Approach Research Articles

AB085. Trans-cortical trans-ventricular approach to pineal tumors: a case series.

Attributing to its deep-seated location, surrounded by significant vessels, surgical management of pineal gland lesions is still considered a challenge. Various surgical approaches are employed to access these lesions, based on patient-specific risks and benefits. Each approach has its merits and demerits. In this study, we aim to narrate our experience with trans-cortical trans-ventricular (TT) approach for pineal tumor resection. We aim to outline the procedure details, safety, efficacy, and treatment outcome of TT. This is a single-center, consecutive case series. All patients with pineal gland tumors who underwent surgical intervention, namely biopsy or resection using TT approach from 2000 to 2023 were included. Data for the patient characteristics, intraoperative details and complications were collected from the hospital's database. Mean [standard deviation (SD)] and frequency (proportions) were calculated for continuous and discrete variables, respectively. We identified 13 patients, mean age 24 (SD: 13) years in our case series. Of them, 8 (61.5%) were male. Most common presenting complains were headaches (69%), nausea/vomiting (38.5%), seizure (23%), and visual deficit (23%). Most patients, 60%, had high grade tumor and average size of tumors were 43.5 mm (SD: 18.45 mm). Pilocytic astrocyotma (23%) and pineal parenchymal tumor of intermediate differentiation (23%) were the most common diagnoses. In total, nine patients had pineal gland lesion biopsy done using TT approach along with the cerebrospinal fluid (CSF) diversion. Of them, four had tumor resection done using the same approach. Whereas four patients had primary excision done using TT approach. There were no intra-operative complications. Two patients had post-operative seizures which were treated with anti-epileptics. We did not identify any long-term sequalae attributed to this approach. We presented our data regarding the safety, efficacy, and outcomes of trans-cortical trans-ventricular approach for pineal tumor surgical management. Utilizing this novel approach for pineal lesion resection can be a great addition to surgeons' armamentarium. This unique approach allows to access the tumor for biopsy/resection and perform CSF diversion procedure, simultaneously. Moreover, the same incision can be used for the second/redo surgery.

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.

Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection.

Colloid cysts of the third ventricle are histologically benign lesions that can cause obstructive hydrocephalus and death. Historically, colloid cysts have been removed by open microsurgical approaches. More recently, minimally invasive endoscopic and port-based techniques have offered decreased complications and length of stay, with improved patient satisfaction. A single-center retrospective analysis of patients with colloid cysts who underwent surgery at a large tertiary care hospital was performed. The cohort was assessed based on the surgical approach, comparing endoscopic resection to open microsurgical resection. The primary endpoint was rate of perioperative complications. Univariate analysis was used to assess several procedure-related variables and the cost of treatment. Multivariate analysis was used to assess predictors of perioperative complications. Total inpatient cost for each case was extracted from the health system financial database. The study included 78 patients with colloid cysts who underwent resection either via an endoscopic approach (n = 33) or through a craniotomy (n = 45) with an interhemispheric-transcallosal or transcortical-transventricular approach. Nearly all patients were symptomatic, and half had obstructive hydrocephalus. Endoscopic resection was associated with reduced operative time (3.2 vs 4.9 hours, p < 0.001); lower complication rate (6.1% vs 33.1%, p = 0.009); reduced length of stay (4.1 vs 8.9 days, p < 0.001); and improved discharge to home (100% vs 75.6%, p = 0.008) compared to microsurgical resection. Coagulated residual cyst wall remnants were more common after endoscopic resection (63.6% vs 19.0%, p < 0.001) although this was not associated with a significantly increased rate of reoperation for recurrence. The mean follow-up was longer in the microsurgical resection group (3.1 vs 4.9 years, p = 0.016). The total inpatient cost of endoscopic resection was, on average, one-half (47%) that of microsurgical resection. When complications were encountered, the total inpatient cost of microsurgical resection was 4 times greater than that of endoscopic resection where no major complications were observed. The increased cost-effectiveness of endoscopic resection remained during reoperation. Endoscopic resection of colloid cysts of the third ventricle offers a significant reduction in perioperative complications when compared to microsurgical resection. Endoscopic resection optimizes nearly all procedure-related variables compared to microsurgical resection, and reduces total inpatient cost by > 50%. However, endoscopic resection is associated with a significantly increased likelihood of residual coagulated cyst wall remnants that could increase the rate of reoperation for recurrence. Taken together, endoscopic resection represents a safe and effective minimally invasive approach for removal of colloid cysts.

Commentary: Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

Commentary: Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

A paradigm shift toward less radicality in the treatment of craniopharyngioma (CP) has increasingly gained recognition. In selected patients, a less invasive approach aiming at cyst decompression may be suitable. To present our experience with the endoscopic transcortical-transventricular approach (ETTA) for the treatment of CP located in the third ventricle, describe our surgical technique, and explore the results reported in the literature. Data for third ventricular CPs treated using ETTA in 2 tertiary medical centers between 2006 and 2020 were retrospectively reviewed. Cystic, mixed lesion, new, and recurrent cases were included. ETTA aimed at cyst fenestration, subtotal or partial tumor resection, managing the hydrocephalus, or a combination of these modalities. Fractionated radiotherapy (RT) was performed (54 Gy in 30 fractions). The described approach was performed in 13 patients with a mean age of 30.2 years. Tumor excision was attempted in 10 patients. Cystic fenestration alone was conducted in 3 patients, followed by intracystic catheter implantation in 2 patients. Permanent diabetes insipidus developed in 3 patients, and 1 patient experienced a surgical site infection. The recurrence rate for ETTA + RT (pre-ETTA in 33.3%) was 2/9 (22.2%) after a mean follow-up of 21.3 months. Four patients did not undergo RT after ETTA, and all these patients experienced recurrences after a mean follow-up of 15.5 months. Hydrocephalus resolved in all 6 patients who presented with accompanying hydrocephalus. ETTA combined with adjuvant RT is a safe and effective option in the management of cystic or predominantly cystic CP extending into the third ventricle. This procedure also effectively treats the accompanying hydrocephalus.

Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy.Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients.Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred.Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.

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.

Microsurgical endoportal MRI/US-navigated approach for the resection of large intraventricular tumours: a 20-consecutive patients case series

Objectives Deep lesions located in lateral and third ventricles can be accessed thorough interhemispheric transcallosal or transcortical trans-ventricular approaches. Traditional brain retractors are made by ‘non-cerebral engineered’ spatulas, which do not equally distribute pressure on surrounding structures damaging brain. In this paper, we present a series of 20 intraventricular tumours resected through a MRI/US-navigated microscopic transcortical endoportal approach. Patients and methods Between January 2014 and December 2017, 20 patients underwent US-MRI neuronavigated (Esaote®, Genova, Italy) transcortical endoportal (Vycor® Viewsite Brain Access System TC Model, Vycor® Medical Inc., Boca Raton, FL) surgery for intraventricular deep-seated lesions with the intent to reach maximal safe resection. Results Gross total removal was achieved in 14 patients (70%). The only prognostic factor that resulted in statistical significance related to surgical radicality from multivariate analysis was white matter infiltration (p = 0.043), regardless of other tumour (dimensions, origin and location inside ventricular system, histopathology) and patient (age, gender, clinical presentation) characteristics. The mean duration of surgery was 225.9 min (± 59). Neither critical events, nor major bleedings, nor intraoperative deaths occurred during surgery. One case of postoperative CSF infection (5%) was registered. Six patients (30%) required permanent CSF drainage system (Ommaya reservoir, VP shunt) in the postoperative period. The mean Functional Independence Measure (FIM) score at last follow-up was 105 (range: 65–124). Conclusions Transcortical transventricular endoportal surgery seems to be a valuable alternative to transcallosal surgery, although further prospective multicentre studies with larger number of patients, evaluation of pre- and post-operative neuropsychological outcomes and achievement of postoperative DTI and f-MRI are needed to confirm our results.

Endoscopic transcortical-transventricular approach in treating third ventricular craniopharyngiomas: technical note and literature review

Endoscopic transcortical-transventricular approach in treating third ventricular craniopharyngiomas: technical note and literature review

Cyst fenestration and Ommaya reservoir placement in endoscopic transcortical transventricular approach for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly

The efficacy of the endoscopic transcortical transventricular approach (ETTA) for craniopharyngioma in the third ventricle with hydrocephalus has been reported focusing on its reduced invasiveness. On the other hand, suprasellar craniopharyngioma without ventriculomegaly is generally surgically managed by craniotomy or the endoscopic endonasal approach (EEA). Here, we report an elderly patient who received cyst fenestration and Ommaya reservoir placement in ETTA for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly. The ETTA as a less invasive procedure is feasible in patients not only with intraventricular craniopharyngioma but also with suprasellar craniopharyngioma without hydrocephalus provided a navigational system is applied and the surgeon has ample experience with transcranial endoscopic procedures.

Harvey Cushing's craniopharyngioma treatment: Part 2. Surgical strategies and results of his pioneering series.

Harvey Cushing (1869-1939) developed pioneering surgical techniques for craniopharyngioma (CP) removal. This study exhaustively analyzes the pathological variables and surgical strategies that influenced Cushing's results in his entire series of CP patients. The CP records from Cushing's Brain Tumor Registry were carefully reviewed, as were his CP cases published in medical monographs and scientific reports. One hundred twenty-four tumors with characteristics typical of CP comprise Cushing's entire series (CP124). Cushing performed 198 surgical procedures in the patients in whom these tumors were treated, with a 23% mortality rate within the first 2 months after surgery. Three periods in Cushing's CP surgical career can be differentiated: an early period (1901-1917, 39 patients) characterized by his use of the transsphenoidal approach and limited cyst drainage procedures, an intermediate period (1919-1925, 42 patients) in which the subfrontal approach was the standard procedure and maximal removal was attempted, and a late period (1926-1932, 43 patients) characterized by the use of air ventriculography for topographical diagnosis and limited resections via a transventricular approach. Among Cushing's CP series were 92 cases that were pathologically verified (CP92). In this subcohort, the unilateral subfrontal approach was predominantly used (72% of cases), followed by the transsphenoidal (15%) and frontal transcortical-transventricular (8%) approaches. Drainage of the CP cystic component or partial excision of the solid component was achieved in 61% of the cases, subtotal removal in 23%, and macroscopic total removal in 10%. Satisfactory outcomes were obtained in 55% of the patients in CP92, whereas poor outcomes and/or death related to hypothalamic injury was observed in 28%. Postoperative symptoms related to hypothalamic dysfunction occurred 53% of the time. The subfrontal approach yielded the highest rates of radical removal (p < 0.001) and good outcomes (p = 0.01). Partial removals were associated with the highest rates of poor outcomes, including death (p = 0.009). Cushing's removal of CPs with a primary infundibulo-tuberal topography or showing third ventricle invasion was associated with the highest rates of hypothalamic injury (p < 0.001) and the worst outcomes (p = 0.009). Harvey Cushing's techniques and surgical philosophy varied substantially throughout his career. The experience he gained with this large CP series made him aware of the importance of limiting the extent of tumor removal and leaving untouched the tumor portion strongly adhered to the hypothalamus.

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.

Navigation-assisted transcortical transventricular approach for paraventricular cavernoma: A technical note and review of the literature

The surgery of paraventricular cavernoma remains a challenge for the neurosurgeon. Few approaches have been specially described for paraventricular cavernoma in literature. We present a patient with a symptomatic paraventricular cavernoma in the dorsal portion of the right lateral ventricles roof causing ventricular hemorrhage, and review his surgical approaches. This patient underwent a navigation-assisted transcortical transventricular approach resulting in a complete resection without any neurologic deficits. The approach allows a safe and effective resection of paraventricular cavernomas.

Surgical management of colloid cysts in children: experience at a tertiary care center.

Colloid cysts are uncommon lesions in the pediatric age group, which most commonly occur in the fourth through fifth decades. The authors hereby report a series of 36 patients with colloid cysts in the pediatric age group. A retrospective chart review was conducted on all patients with colloid cyst who underwent surgery in our institute between November 2003 and December 2016 (13years). Patients above the age of 18 were excluded from the study. They were analyzed based on clinical presentation, radiological findings, surgical approaches, and outcome. There were 36 pediatric patients selected for the study. Age ranged from 8 to 18years. The male-to-female ratio was 3.5:1. Headache and vomiting were the most common symptoms, and papilledema is the most common clinical sign. The mean duration of symptoms was 9months (range 1day to 5years), but 27 (75%) of the children had precipitous symptoms just before presentation. Preoperative CT showed a hyperdense non-enhancing lesion in the majority of cases. Endoscopic excision was done in 13; 5 patients underwent transcortical transventricular excision, while transcallosal approach was opted for in 17 patients. In one patient, the colloid cyst could not be removed endoscopically and had to be converted to transcortical transventricular approach. Postoperatively, five patients developed CSF leak. They were successfully managed conservatively. One patient had operative site extra dural hematoma and underwent re-exploration, and two patients had transient hemiparesis which improved spontaneously. The median follow-up period was 9months in the 30 available patients. Though no formal neuropsychological testing was done at follow-up, all children appeared to be doing well without memory disturbances. Pediatric colloid cysts are less common and may show rapid deterioration. Timely surgery results in a permanent cure with minimum morbidity. The results of either micro neurosurgical or endoscopic operative excision of colloid cysts in children are excellent. All children who are symptomatic with raised intracranial pressure due to a third ventricular colloid cyst should undergo definitive surgery. There were no major permanent deficits in memory or disconnection syndromes observed with the limited anterior colostomy.

Endoscopic Treatment of Colloid Cysts of Third Ventricle: Study of Three Cases

Introduction: Colloid cyst of the third ventricle is a rare intracranial benign tumor. Traditionally, treatment is carried out by transcallosal or transcortical transventricular approach. Currently, the endoscopic treatment of these lesions is increasingly used. We reported our preliminary experience about three cases of colloid cysts treated by neuroendoscopy. Methods and Patients: We conducted a retrospective study on the analysis of medical records of three patients with colloid cyst who had been operated endoscopically in our department. We used a rigid neuroendoscope of 2.7 mm in diameter, with an optical 30°. Coagulation of the wall, followed by a puncture aspiration of cystic contents and partial resection of its wall were performed during the surgery. The mean follow-up time was two years. Results: Patients were 35, 47, and 53 years old. They were male. The dominant clinical symptom was headaches with consciousness disorder. Brain MRI allowed the diagnosis in all cases. The mean operation time was 100 minutes. A case of intraoperative hemorrhage was observed, necessitating the installation of an EDV. The outcome was favorable in two patients, and after surgery we observed one case of meningitis treated. One case of transient amnesia and one death were reported. Conclusion: Preliminary results of endoscopic treatment of colloid cysts were encouraging. It is a promising technique in our department. However, more investigation is necessary.

Delayed intraventricular metastasis of clival chordoma.

Sir, Intracranial chordomas are typically clival and extradural in location, yet these tumors can obviously invade the dura. However, primary intradural chordomas without local extension is a rare event with approximately 47 cases reported in literature. Furthermore, all intradural chordoma reports appear to be extraventricular in location.[1,2] In addition, through advances in technology and optics, neuroendoscopy has come to the forefront as a mainstream operative technique. Some tumors are more conducive to endoscopic biopsy or resection than others due to hemorrhagic or consistency. We present this unique case of an intraventricular recurrence of a clival chordoma and successful use of neuroendoscopy to explore and resect the tumor. A 60-year-old male, with a history of clival chordoma resection and adjuvant radiation nearly 10 years prior, presented with an intraventricular lesion on magnetic resonance imaging (MRI) obtained for stroke workup of the left sided weakness. Physical examination showed right third nerve palsy, left facial droop, and left sided weakness. MRI demonstrated an intraventricular enhancing lesion within the right lateral ventricle [Figure ​[Figure1a1a and ​andb].b]. No other evidence of metastasis was identified. The decision was made to endoscopically biopsy and resects the intraventricular lesion via a transcortical-transventricular approach [Figure 1c]. Postoperative MRI demonstrated gross total resection [Figure 1d]. The histopathologic diagnosis of the tumor was chordoma. No postoperative radiation was given. On 6-month follow-up imaging, the lesion has not recurred. Figure 1 (a and b) Preoperative magnetic resonance imaging demonstrates an enhancing lesion, approximately 1.5 cm × 1.0 cm, along the ependymal surface within the right lateral ventricle caudothalamic notch. (c) Intraoperative view of intraventricular ... This case illustrates a unique occurrence of intraventricular recurrence of clival chordoma approximately 10 years after initial resection with good result via an endoscopic technique. Prior reports have typically focused on intradural, extraventricular metastases. A solitary intraventricular chordoma neoplasm is a rare, interesting event. Furthermore, neuroendoscopy is a useful technique for tumor resection and proves viable in the resection of chordomas. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Case Report of a Septum Pellucidum Cavernoma Surgically Resected via Inferior Parietal Approach and Short Literature Review

Background and Importance: Cavernomas of the septum pellucidum represent an extremely rare subtype of CNS cavernous angiomas which are a rare subtype of CNS tumors. Intraventricular cavernomas of the body of the lateral ventricle are usually treated by the transcallosal approach. Clinical Presentation: We present a case of a fifty-eight year old man with a septum pellucidum cavernoma successfully treated operatively by means of the inferior parietal transcortical transventricular approach. This unusual and scarcely documented tumor was situated at the posterior third of the septum pellucidum. The patient had a good recovery with no focal deficit. Conclusion: Septum pellucidum cavernomas are extremely rare lesions. Inferior parietal transcortical approach is a safe alternative to the commonly used transcallosal approach for lesions of the posterior half of the septum pellucidum.

Endoscopic Resection of Third Ventricular Colloid Cyst

Introduction Colloid cysts usually arise in the third ventricle. They cause obstructive hydrocephalus by blocking one or both foramen of Monro. Cases of sudden death were reported in presence of colloid cyst. Different surgical approaches exist for the resection of this pathology. The most popular approaches are the transcortical transcallosal approach to the third ventricle. The other approach is endoscopic transcortical transventricular approach.

Intraoperative Conversion from Endoscopic to Open Transcortical-Transventricular Removal of Colloid Cysts as a Salvage Procedure.

Objective: To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome.Methods: Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection. Based on common cyst location in the roof of the third ventricle, we propose a simple classification of surgical operative zones based on relationships defined by the anterior column of the fornix, the septal vein, and the medial atrial vein.Results: Complete capsule removal was achieved in 35% of endoscopic operations, 100% of transcortical-transventricular operations, and 63% of the interhemispheric operations. Operative time was 176 minutes for endoscopic operations, whereas the operative time for cases that converted to the transcortical-transventricular approach was 190 minutes (p=0.39).Conclusion: A surgical-based classification of zones within the roof of the third ventricle that can be accessed with microsurgical techniques is proposed. Both endoscopic and microsurgical cyst aspiration and excision remain options. We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems.Consent was formally obtained or waived for all subjects present within this study.

P12.06 * INTRAVENTRICULAR BRAIN TUMORS: PECULIARITIES OF SURGICAL TREATMENT

INTRODUCTION: Intraventricular brain tumors account for approximately 10% of all tumors of the central nervous system. Despite the fact that some of these tumors are aggressive high grade lesions, most of them are histologically benign and potentially curable after surgical resection. Considering the slow growth of this tumors, for a long time this lesions remain clinically asymptomatic, until they reach significant size, which makes surgical removal technically difficult. The aim of the current study was to identify patterns of results of surgical treatment of patients with intraventricular tumors, depending on the lesion location and its degree of differentiation. MATERIAL AND METHODS: A retrospective analysis of 54 consecutive surgical interventions on intraventricular brain tumors that were treated at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology in the period from January 2004 to February 2014. Localization of tumors was as follows: the fourth ventricle - 32 (59%), third ventricle - 13 (24%), lateral ventricles - 9 (17%). Neurological symptoms due to increased intracranial pressure was a common clinical manifestation of tumors for all patients. We used the following surgical approaches: suboccipital craniotomy for tumors of the fourth ventricle, transcallosal or transcortical-transventricular approach to the third ventricle and transcortical approach to lesions of lateral ventricles. Histological structure of the tumors: ependymoma - 13 (24%), astrocytoma - 12 (22%), medulloblastoma - 8 (14.0%), colloid cyst - 7 (13.0%), choroid plexus papilloma - 6 (11%), meningioma - 3 (6%), choroid plexus carcinoma - 1 (2%), teratoma - 1 (2%), central neurocytoma - 1 (2%), dermoid cyst - 1 (2%), chordoid glioma of the third ventricle - 1 (2%). The degree of tumors differentiation: grade I-II - 37 (69%), grade III-IV - 17 (31%). RESULTS: According to the data, among intraventricular tumors prevail the tumors of the fourth ventricle (59%), the most frequent histological type - ependymoma (24%). The total tumor removal was achieved in 38 patients (70%), of whom in 33 (87%) the degree of tumor differentiation was grade I-II. Postoperative mortality was 9% (5 patients), of which 4 (80%) - with the localization of the tumor in the third and fourth ventricles. The results of treatment were assessed according to Karnofsky scale: more than 60 points - 46 (85%) patients. CONCLUSIONS Acceptable results of surgical treatment of intraventricular brain tumours are in direct dependence from the tumor localisation and its histological structure. The most unfavorable factor is the localization of tumors in close proximity to the brainstem and the low degree of tumor differentiation.