scholarly journals Contralateral Interhemispheric Transcallosal Transchoroidal Approach for Resection of a Tumor in the Lateral Wall of the Third Ventricle: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E197-E197
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Surgical Approach ◽  
Third Ventricle ◽  
Video Recording ◽  
Lateral Wall ◽  
Metastatic Lesion ◽  
Foramen Of Monro ◽  
The Third ◽  
Institutional Review ◽  
Surgical Field ◽  
Selection Of

Abstract Third ventricular tumors pose a surgical challenge, given the intricate surrounding anatomy and depth of the surgical field. A surgical approach to these lesions can involve several different trajectories, the selection of which is dependent on the location of the tumor. Approaches include transforaminal, translamina terminalis, interforniceal, occipital transtentorial, endoscopic transventricular, transchoroidal, and supracerebellar infratentorial. This patient had a metastatic lesion within the lateral wall of the third ventricle. The selection of the surgical approach was dependent on the laterality of the tumor. The foramen of Monro was identified, and landmarks were confirmed. The choroid plexus could then be retracted medially, and the choroidal sulcus was identified. The sulcus was entered laterally to minimize the risk of transgressing the fornix. The tumor was identified along the lateral third ventricular wall, and the plane between the tumor and normal plane was readily created. The tumor was then removed entirely, and postoperative imaging demonstrated a complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Anterior Interhemispheric Transcallosal Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E240-E241
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Complete Resection ◽  
Institutional Review Board ◽  
Transcallosal Approach ◽  
The Third ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract This patient had a large left ventral thalamic cavernous malformation abutting the third ventricle with evidence of recent hemorrhage. The patient was placed supine with the head in the horizontal position with the dependent hemisphere down to permit use of the anterior interhemispheric transcallosal approach. The lateral ventricle is entered, and the septum pellucidum is opened to prevent it from obstructing the surgical field. The deep cavernous malformation is located with stereotactic neuronavigation and removed piecemeal with the aid of lighted suckers and bipolars. Surgical visualization and postoperative imaging demonstrate a complete resection of the lesion, and the patient remained neurologically stable postoperatively. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Left Interhemispheric Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E154-E154
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Lateral Ventricle ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Mass Effect ◽  
Cavernous Malformations ◽  
Transcallosal Approach ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract Thalamic cavernous malformations pose variable surgical challenges given that the location and size of the lesion often determine the approach surgical trajectory. The patient in this case has a large thalamic cavernous malformation that results in a mass effect on the third ventricle and directly abuts the lateral ventricle. A small interhemispheric craniotomy is performed to allow for an anterior interhemispheric transcallosal approach to the lesion. The lateral ventricle is accessed, and the septum is removed to enhance visualization of the surgical field. A small rim of normal parenchyma on the lateral margin of the thalamus is transgressed, and the cavernous malformation is entered. The lesion is removed in a piecemeal manner. Use of counter traction assists with the piecemeal removal. The lighted suction is critical during inspection and manipulation of the lesion within the resection cavity given the limited lighting deep within the cavity. The lesion was removed completely, and postoperative imaging confirms gross total resection. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute.

Surgical management of cavernous malformations of the third ventricle

1994 ◽  
Vol 80 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Yoichi Katayama ◽  
Takashi Tsubokawa ◽  
Tsuyoshi Maeda ◽  
Takamitsu Yamamoto
Keyword(s):  
Third Ventricle ◽  
Clinical Manifestations ◽  
Lateral Wall ◽  
Endocrine Function ◽  
Surgical Approaches ◽  
Foramen Of Monro ◽  
Aggressive Approach ◽  
Cavernous Malformations ◽  
The Third ◽  
Initial Symptoms

✓ In order to determine adequate therapeutic approaches for cavernous malformations of the third ventricle, the authors reviewed a series of five such malformations managed at their institution and nine others reported in the literature. Four subgroups were identified in terms of the site of origin and could be characterized by different clinical manifestations: visual field defects and endocrine function deficits in patients with malformations in the suprachiasmatic region (six cases); symptoms caused by hydrocephalus in those with malformations in the foramen of Monro region (five cases); and deficits of short-term memory in those with malformations in the lateral wall (two cases) or of the floor of the third ventricle (one case). Unlike cavernous malformations at other locations, malformations of the third ventricle frequently demonstrated rapid growth (43%) and mass effects (71%). The surgical or autopsy findings suggested that the growth was attributable to repeated intralesional hemorrhages. Extralesional hemorrhage was also not uncommon, occurring in 29% of patients. Such tendencies require the adoption of a more aggressive approach to this particular group of cavernous malformations as compared to those in other locations. The risks of regrowth and extralesional hemorrhage appear to be reduced only by complete excision. The surgical approaches adopted should be aimed at providing the best access to the site where the malformation has arisen. The translamina terminalis approach for cavernous malformations in the suprachiasmatic region, the transventricular or transcallosal interfornicial approaches for those in the foramen of Monro region and the transvelum interpositum approach for those in the lateral wall or the floor of the third ventricle appear to be appropriate. In order to select the adequate surgical approach, precise diagnosis of the site of origin is crucial. In addition to neuroimaging techniques, the patient's initial symptoms provide valuable information.

Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

2018 ◽  
Vol 17 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Alberto Feletti ◽  
Riccardo Stanzani ◽  
Matteo Alicandri-Ciufelli ◽  
Giuliano Giliberto ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Blood Clot ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Posterior Fossa Surgery ◽  
The Third ◽  
Blood Clots ◽  
Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

scholarly journals Left Retrosigmoid Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E2-E2
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Preoperative Planning ◽  
Cavernous Malformation ◽  
Video Recording ◽  
Close Inspection ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field ◽  
Cerebellar Peduncle

Abstract Pontine cavernous malformations are highly morbid lesions that require thorough preoperative planning of the surgical approach and meticulous surgical technique to successfully remove. The patient in this case has a large pontine cavernous malformation coming to the parenchymal surface along the pontine–middle cerebellar peduncle interface. The depth of the surgical field and narrow trajectory of approach require use of lighted suction, lighted bipolar forceps, and stereotactic neuronavigation to successfully locate and remove the entire lesion. The cavernous malformation is removed in a piecemeal manner with close inspection of the resection cavity for any remnants. Postoperative imaging demonstrates gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Purely Endoscopic Resection of Colloid Cysts

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS51-ONS56 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Charles Teo ◽  
Ali Ghahreman ◽  
Bernard Kwok
Keyword(s):  
Endoscopic Resection ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Foramen Of Monro ◽  
The Third ◽  
Colloid Cysts ◽  
Study Support

Abstract Objective: To further assess the safety and long-term efficacy of endoscopic resection of colloid cysts of the third ventricle. Methods: A retrospective review of a series of 35 consecutive patients (18 male, 17 female) with colloid cysts treated by endoscopic surgery was undertaken. Results: The mean patient age was 32.4 years (range, 11–54 yr). Headache was the most common presenting symptom (22 patients). The average tumor size was 18 mm (range, 3–50 mm). The endoscopic technique could not be completed in six patients, necessitating conversion to an open craniotomy and a transcortical approach to the colloid cyst. All patients had histologically confirmed colloid cysts of the third ventricle, and complete resection of the lesion was confirmed macroscopically and radiologically in all patients. There were no deaths. Two patients developed aseptic meningitis without any permanent sequelae. One patient developed unilateral hydrocephalus attributable to obstruction of the foramen of Monro, which was treated with endoscopic septum pellucidotomy. The median follow-up period was 88 months (range, 10–132 mo). There was one asymptomatic radiological recurrence. No seizures occurred after surgery. Conclusion: The results of this study support the role of endoscopic resection in the treatment of patients with colloid cysts as a safe and effective modality. In some cases, conversion to an open procedure may be required. Additional follow-up will be required to continue to address the duration of lesion-free survival.

Endoscopic Fenestration of Cavum Septum Pellucidum Cysts to the Third Ventricle: Technical Note

2020 ◽  
Vol 19 (4) ◽  
pp. E434-E439
Author(s):  
Alexandre Simonin ◽  
Omar Bangash ◽  
Arjun S Chandran ◽  
Erik Uvelius ◽  
Christopher Lind
Keyword(s):  
Surgical Procedure ◽  
Clinical Presentation ◽  
Third Ventricle ◽  
Technical Note ◽  
Septum Pellucidum ◽  
Imaging Studies ◽  
Foramen Of Monro ◽  
Cavum Septum Pellucidum ◽  
The Third ◽  
Endoscopic Fenestration

Abstract BACKGROUND AND IMPORTANCE Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are common incidental findings on imaging studies. However, they may rarely present with symptoms related to the obstruction of the foramen of Monro by the cyst leaflets. There is no consensus regarding the management of symptomatic CSP and CV cysts. We present an original transcavum interforniceal endoscopic fenestration technique. The step-by-step surgical procedure and two illustrative cases are presented. CLINICAL PRESENTATION A 31-yr-old male and a 24-yr-old woman presented with symptomatic CSP and CV cysts. For both patients, neuronavigation was used to plan the procedure. An endoscope was introduced into the cyst through a right frontal burr-hole. After an examination of the endoscopic anatomy, a communication between the cyst and the third ventricle was performed using an endoscopic forceps. In both cases, directly after the fenestration, cerebrospinal fluid (CSF) passed through the communication, and the collapse of the cyst was appreciated. Symptoms were relieved in both patients, and neuropsychological assessment improved. Postoperative imaging showed a reduction in the cyst bulge, and patent foramen of Monro. CONCLUSION Endoscopic fenestration of CSP and CV cysts to the third ventricle through an interforniceal navigated approach is a feasible and efficient surgical procedure. Theoretical advantages include a single tract through noneloquent brain, a perpendicular trajectory to the membrane for fenestration, and a large CSF space beyond the fenestration point.

Frontobasal Interhemispheric Trans-Lamina Terminalis Approach for Suprasellar Lesions

2005 ◽  
Vol 56 (suppl_4) ◽  
pp. ONS-418-ONS-424 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Nicolas de Tribolet
Keyword(s):  
Patient Selection ◽  
Surgical Approach ◽  
Postoperative Care ◽  
Operative Technique ◽  
Third Ventricle ◽  
Lamina Terminalis ◽  
The Third ◽  
Interhemispheric Approach

Abstract THE FRONTOBASAL INTERHEMISPHERIC APPROACH for suprasellar tumors currently incorporates technological advancements and refinements in patient selection, operative technique, and postoperative care. This technique is a valid choice for the removal of suprasellar lesions with extension into the third ventricle without major sequelae related to the surgical approach. The method described here reflects the combination of the frontal interhemispheric and trans-lamina terminalis approaches.

Technical strategies for the transcallosal transforaminal approach to third ventricle tumors: expanding the operative corridor

2014 ◽  
Vol 14 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Prayash Patel ◽  
Aaron A. Cohen-Gadol ◽  
Frederick Boop ◽  
Paul Klimo
Keyword(s):  
Short Term Memory ◽  
Third Ventricle ◽  
Signs And Symptoms ◽  
Surgical Approaches ◽  
Easy Method ◽  
Foramen Of Monro ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Transforaminal Approach ◽  
Common Group

Object There are a number of surgical approaches to the third ventricle, each with advantages and disadvantages. Which approach to use depends on the location of the lesion within the ventricle, the goals of the operation, and the surgeon's experience. The authors present their results in children with a modified approach through the expanded foramen of Monro. Methods A retrospective study was conducted to identify and analyze all children who underwent what the authors term the “expanded transforaminal” approach to the third ventricle between 2010 and 2013. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up. Results Twelve patients were identified (5 female, 7 male) with a mean age of 9 years (range 2–19 years). Two patients underwent gross-total resections, whereas 10 resections were less than total. There were no instances of venous infarction, significant intraoperative bleeding, or short-term memory deficits. Of the 12 patients, 7 suffered a total of 17 complications. Disruption of neuroendocrine function occurred in 4 patients: 2 with transient diabetes insipidus, 2 with permanent panhypopituitarism, and 1 with central hypothroidism (1 patient had 2 complications). The most common group of complications were CSF-related, including 2 patients requiring a new shunt. There was 1 approach-related injury to the fornix, which did not result in any clinical deficits. One child with an aggressive malignancy died of tumor progression 6 months after surgery. Of the remaining 11 patients, none have experienced tumor recurrence or progression to date. Conclusions The expanded transcallosal transforaminal approach is a safe and relatively easy method of exploiting a natural pathway to the third ventricle, but there remain blind zones in the anterosuperior and posterosuperior regions of the third ventricle.

Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts

2014 ◽  
Vol 120 (6) ◽  
pp. 1471-1476 ◽  
Author(s):  
Maurizio Iacoangeli ◽  
Lucia Giovanna Maria di Somma ◽  
Alessandro Di Rienzo ◽  
Lorenzo Alvaro ◽  
Davide Nasi ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Invasive Procedure ◽  
Colloid Cyst ◽  
Complete Resection ◽  
Safe Alternative ◽  
Foramen Of Monro ◽  
The Third ◽  
Postoperative Mri ◽  
Tela Choroidea ◽  
Colloid Cysts

Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.

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