Surgical Experience For Tumor In The Third Ventricle Via A Transcallosal-Interforniceal Approach

Background:the third ventricle is a small, vital area located in the center of the brain surrounded by critical structure. It is impossible to reach it cavity without incising some neural structures. Surgical treatment of tumor in this area has been a great challenge to neurosurgeons. Three primary surgical corridors are available for accessing the region: superiorly through the cortex or corpus callosum, anteriorly through the lamina terminalis, and posteriorly through the velum interpositum. Furthermore, there are multiple variations in the transcallosal route such as the interforniceal, subchoroidal, and transchoroidal approaches.Object:to assess the surgical outcome of patients with tumor in the third ventricle via a transcallosal-interforniceal approach.Patients and methods:between January2010and April2012,9patients underwent resection of tumor in the third ventricle via a transcallosal-interforniceal approach at the Second affiliated hospital of Zhejiang University college of medicine were analyzed. Patient demographics, presenting symptoms, pathology, and30-day postoperative morbidity and mortality rates were retrospectively analyzed. Pre-and postoperative magnetic resonance imaging scans were evaluated to determine the anatomic extensions of the lesion.Results:headache was the most common symptom which was found in7patients (78%). Tumor located in the anterior third ventricle was found in6patients including4mtraventricular craniopharyngiomas while3in the middle-posterior third ventricle were identified. Total resection was achieved in7patients (78%), whereas subtotal was done in2patients (22%). The postoperative neurological complications occurred in4patients (45%). Transient mutism occurred most frequently in3patients (33%). None suffered permanent neurological deficits. There was no surgical mortality. Recurrence was detected in1patient after8months’follow-up.Conclusion:the transcallosal-interforniceal approach provides a natural corridor in the midline and affords exposure of lesions involving the anterior, middle and posterior portions of the third ventricle. It minimizes the injuries of neurovascular structures and maximal tumor resection. As long as a well, individualize surgical approach is designed based on preoperative imaging, it is a safe, effective and minimally invasive for surgical treatment of tumors in the third ventricle.