Translamina Terminalis Approach Research Articles

Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches.

Fifty-seven patients with craniopharyngiomas underwent a total of 64 operations. Their clinical follow-up ranged from 2.5 to 15.5 years, with a mean follow-up of 6.5 years. A transsphenoidal approach was used in 35 patients (61%), whereas 22 (39%) were operated on using a pterional approach (in 16 patients, the tumor was found in the suprasellar cisterns, and in 6, the tumor was found in the third ventricle and was removed passing through the lamina terminalis). Total removal of the tumor was achieved in 43 patients (75%). In six patients (11%), fragments of the capsule remained attached to the hypothalamus (subtotal removal), and, in eight patients (14%), the tumor was partially removed. No recurrence occurred in those patients in whom removal was total. Regrowth was observed in two patients (33%) in whom removal was subtotal and in two (25%) in whom removal was partial. Three of them underwent subsequent operations, and a total removal with good clinical outcome was achieved. All patients except two had good postoperative recovery. Twenty patients (35%) required hormonal replacement therapy. When transsphenoidal surgery was used, a total removal of the tumors was achieved in 23 (66%) of the patients. Good clinical outcome was seen in all 35 patients. Six patients (17%) required hormonal replacement therapy. When the pterional approach was used for tumors in the suprasellar cisterns, we achieved total removal of tumors in 15 patients (94%). Good clinical outcome was seen in 20 patients (91%). Eleven patients (50%) required hormonal replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Thalamostriate artery aneurysm within the third ventricle

The authors report the case of a 7-mm saccular aneurysm, located within the third ventricle and arising from the distal portion of a thalamostriate artery. The patient presented with an intraventricular hemorrhage and was treated via a frontotemporal craniotomy with translamina-terminalis approach for resection of the aneurysm. The etiology of the aneurysm was presumed to be idiopathic. Previously only one other third ventricular aneurysm has been reported. An intraventricular aneurysm arising from a perforating artery should therefore be considered as a rare cause of an intraventricular hemorrhage. Potential surgical approaches to third ventricular aneurysms are discussed.

Third ventricle cavernous angioma: Report of two cases

Cavernous angioma arising in the third ventricle is an extremely rare disease. We have reviewed five cases previously reported, as well as our own two cases, and discuss the clinical characteristics of and surgical approach to cavernous angioma at this site. The bifrontal craniotomy and interhemispheric translamina terminalis approach minimize the damage to the brain and allow for an approach to the third ventricle in a wide operative field with minimal compression of the brain itself. We have found this approach to be suitable for surgery on angiomas of the anterior half of the third ventricle.

A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part I. Clinical study

The interhemispheric translamina terminalis approach has made total removal of a craniopharyngioma less risky. Nevertheless, one of the pitfalls of this approach is cutting of the draining veins combined with retraction. A case of craniopharyngioma in which a subcortical hematoma developed is reported. The divided draining veins and the 60-minute retraction period were thought to have caused this complication. We therefore determined the clinical effect of cutting the draining veins and retraction on the regional cerebral blood flow and the motor nerve action potential. There were marked changes and a hematoma occurred mostly when the veins were divided and retraction was applied over the area.

A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part II. Experimental study

The authors have reported a case of a craniopharyngioma removed by the interhemispheric translamina terminalis approach, and the postoperative development of a subcortical hematoma. We suspected that the cause of the subcortical hematoma was dividing the bridging veins and applying a retractor over them. In this paper, we report our experimental study, using dogs and monkeys, to evaluate the effect of cutting the vein and applying a retractor over it. The incidence of a subcortical hematoma was highest (60%) when the veins were cut and the retraction was applied. Vein occlusion only did not cause hematoma to develop, and the retraction alone caused 13% of the hematomas. This clearly indicated that the clinical case reported in Part I developed the subcortical hematoma postoperatively because the frontal bridging vein was cut and a retractor was applied for 60 minutes over the cut vein.