scholarly journals Transcallosal approach for tumors of the lateral and third ventricles

2001 ◽  
Vol 10 (6) ◽  
pp. 1-5 ◽  
Author(s):  
Hahnah Kasowski ◽  
Joseph M. Piepmeier
Keyword(s):  
Tumor Resection ◽  
Neurological Impairment ◽  
Neurological Deficits ◽  
Easy Access ◽  
Anatomical Landmarks ◽  
Optimal Method ◽  
Transcallosal Approach ◽  
Sagittal Sinus ◽  
Large Size ◽  
Brain Relaxation

Tumors that arise within the ventricles present a unique surgical challenge. Because of their deep location, relatively large size, and their association with hydrocephalus, surgical planning requires a careful assessment of the optimal method to access the lesion and to provide adequate exposure for tumor resection. The transcallosal approach to the lateral ventricles often is the best procedure by which to achieve these goals. Partial sectioning of the corpus callosum does not cause significant neurological deficits; however, if the surgery induces additional brain injury, the neurological deficits can be more severe in the presence of a callosotomy. Knowledge of the techniques of transcallosal surgery and careful preoperative planning can reduce the risk of permanent neurological impairment; these range from protection of the cortical veins that drain into the superior sagittal sinus to brain relaxation and ventricular drainage, as well as proper identification of anatomical landmarks within the ventricle. The transcallosal approach can offer a relatively easy access to the lateral and third ventricles, and with proper planning it can reduce the morbidity associated with resection of lesions within these compartments.

scholarly journals Surgery in tumors of the lateral ventricles – last 8 years experience

2014 ◽  
Vol 21 (1) ◽  
pp. 61-73
Author(s):  
Mugurel Radoi ◽  
Leon Danaila ◽  
Florin Stefanescu ◽  
Daniel Petrescu ◽  
Ram Vakilnejad
Keyword(s):  
Lateral Ventricle ◽  
Clinical Symptoms ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Neurological Deficits ◽  
Subtotal Resection ◽  
Transcallosal Approach ◽  
Ventriculoperitoneal Shunting ◽  
Transcortical Approach

Abstract Introduction: Tumors of the lateral ventricle are rare lesions including a large variety of benign or malignant tumors. These tumors could originate in the ventricular wall or arising and expanding within the lateral ventricle from the surrounding neural structures. The purpose of this study is to discuss postoperative results and factors that affected the preference for transcallosal or transcortical approach. Material and methods : We performed a retrospective study, lasted between 2005- 2013, that comprised 26 consecutive patients who underwent operation for lateral ventricle tumors. The main clinical symptoms and signs were associated with the localization and size of the tumors. Cerebral computed tomography and magnetic resonance imaging were used to determine the location and expansion of each tumor. The transcortical approach was used in 17 patients and the transcallosal approach was used in 9 patients. Results : Total tumor resection was achieved in 73% of cases (19 patients). Most frequent histological tumor’s type was glioblastoma, choroid plexus papilloma, ependymoma and meningioma. Signs of increased intracranial pressure were most dominant. One patient died because of postoperative intraventricular hemorrhage. Additional neurological deficits were seen in 3 patients and postoperative seizure occurred in three patients. One patient with preoperative hydrocephalus required ventriculoperitoneal shunting after tumor’s resection. Two patients developed postoperative epidural hematoma and one required reoperation. 15 of 26 patients received postoperative radiotherapy and 6 of them received adjuvant chemotherapy. The mean duration of postoperative evaluation was 24,32 (range 5-92). Excepting the cases with subtotal resection, two patients were reoperated for recurrences. Conclusions : The nature, size, location and vascularization of intraventricular tumors are the most important elements influencing the choice of surgical approach. Surgeons must evaluate all these factors and prefer the short and safe way to remove the tumor.

scholarly journals Spinal Nerves Schwannomas: Experience on 367 Cases—Historic Overview on How Clinical, Radiological, and Surgical Practices Have Changed over a Course of 60 Years

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Jacopo Lenzi ◽  
Giulio Anichini ◽  
Alessandro Landi ◽  
Alfonso Piciocchi ◽  
Emiliano Passacantilli ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Neurological Impairment ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Diagnostic Tools ◽  
Treatment Goals ◽  
Neurophysiologic Monitoring ◽  
Spinal Nerves ◽  
Treatment Techniques ◽  
Before And After

Background.Spinal schwannomas are common benign spinal tumors. Their treatment has significantly evolved over the years, and preserving neurological functions has become one of the main treatment goals together with tumor resection.Study Design and Aims.Retrospective review focused on clinical assessment, treatment techniques, and outcomes.Methods.A retrospective study on our surgical series was performed. Clinical and operative data were analyzed. In regard to neurophysiologic monitoring, patients were retrospectively divided into two groups comparing the outcomes before and after introduction of routine intraoperative neurophysiology tests.Results.From 1951 to 2010, 367 patients overall were treated. Diagnosis was obtained using angiography and/or myelography (pre-CT era), MRI, or CT scan. A posterior spinal approach was used for most patients; complex approaches were adopted for treatment of giant/dumbbell tumors. A trend of neurophysiology monitoring decreasing the rate of post-op neurological deficits was observed but was not statistically significant enough to draft evidence-based conclusions.Conclusions.Clinical and radiological assessment of spinal schwannomas has markedly changed over the course of 50 years. Diagnostic tools have improved, and detection of recurrence has become way more sensitive. Neurophysiologic monitoring has become a useful intraoperative tool to guide resection and prevent post-op neurological impairment.

Impairment Tutorial: Neurological Impairment Evaluation: Overview of Sixth Edition Approaches

2008 ◽  
Vol 13 (2) ◽  
pp. 6-8
Author(s):  
Lorne Direnfeld ◽  
Christopher R. Brigham ◽  
Elizabeth Genovese
Keyword(s):  
Spinal Cord ◽  
Neurological Impairment ◽  
Diagnostic Techniques ◽  
Neurological Deficits ◽  
Sixth Edition ◽  
Pain Disability ◽  
Whole Person ◽  
Disability Questionnaire ◽  
Cervical Plating

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), does not provide a Diagnosis-based estimate of impairment due to syringomyelia, a disorder in which a cyst (syrinx), develops within the central spinal cord and destroys neural tissue as it expands. The AMA Guides, however, does provide an approach to rating a syringomyelia based on objective findings of neurological deficits identified during a neurological examination and demonstrated by standard diagnostic techniques. Syringomelia may occur after spinal cord trauma, including a contusion of the cord. A case study illustrates the rating process: The case patient is a 46-year-old male who fell backwards, landing on his upper back and head; over a five-year period he received a T5-6 laminectomy and later partial corpectomies of C5, C6, and C7, cervical discectomy C5-6 and C6-7; iliac crest strut graft fusion of C5-6 and C6-7; and anterior cervical plating of C5 to C7 for treatment of myelopathy; postoperatively, the patient developed dysphagia. The evaluating physician should determine which conditions are ratable, rate each of these components, and combine the resulting whole person impairments without omission or duplication of a ratable impairment. The article includes a pain disability questionnaire that can be used in conjunction with evaluations conducted according to Chapter 3, Pain, and Chapter 17, The Spine.

scholarly journals Recurrent Sphenocavernous Meningioma

2021 ◽  
Author(s):  
Mizuho Inoue ◽  
Mohamed Labib ◽  
Alexander Yang ◽  
A. Samy Youssef
Keyword(s):  
Tumor Resection ◽  
Intensity Modulated Radiotherapy ◽  
Residual Tumor ◽  
World Health ◽  
Neurological Deficits ◽  
Falciform Ligament ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Who Grade ◽  
Health Organization

AbstractA case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A magnetic resonance imaging (MRI) revealed a large left sphenocavernous meningioma. The patient underwent a frontotemporal craniotomy for tumor resection. Near total resection was achieved with minimal residual in the left cavernous sinus (CS) and orbital apex. The pathology was consistent with meningioma, World Health Organization (WHO) grade I. A follow-up MRI was done 9 months after surgery and showed a growth of the residual tumor, which was treated with intensity modulated radiotherapy. Tumor growth was detected on serial imaging over a 4-year period. Surgical resection was offered. A left frontotemporal craniotomy with pretemporal transcavernous approach was performed. The bone flap was reopened and the dura was opened in a Y-shaped fashion. The roof of the optic canal was drilled off, and the falciform ligament was opened to decompress the optic nerve. The tumor was disconnected from the anterior clinoid region (the anterior clinoid process was eroded by the tumor) and reflected off the wall of the lateral CS. Tumor was adherent to the V2 fascicles (the lateral CS wall was resected in the first surgery) and was sharply dissected off. Gross total resection was achieved. The pathology was consistent with meningioma, WHO grade I. The patient had an unremarkable postoperative course without any new neurological deficits.The link to the video can be found at: https://youtu.be/KVBVw_86JqM.

Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

2000 ◽  
Vol 92 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Madjid Samii ◽  
Marcos Tatagiba ◽  
Gustavo A. Carvalho
Keyword(s):  
Tumor Resection ◽  
Neurological Deficits ◽  
Subtotal Resection ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Content Type ◽  
Simpson Grade ◽  
Petroclival Meningiomas ◽  
Meckel's Cave ◽  
Fine Print

Object. The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).Methods. The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.Conclusions. Theapproach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

scholarly journals Comparative analysis of anterior third ventricle approaches

2020 ◽  
pp. 544-549
Author(s):  
Deepak Kumar Singh ◽  
Kuldeep Yadav ◽  
Rakesh Kumar ◽  
Arun Kumar Singh ◽  
Vipin Kumar Chand
Keyword(s):  
Third Ventricle ◽  
Medical Science ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Colloid Cyst ◽  
Subtotal Resection ◽  
Common Symptom ◽  
Anatomical Landmarks ◽  
Transcallosal Approach ◽  
Transforaminal Approach

Background. Third ventricle tumors are uncommon and account for only 0.6 - 0.9% of all the brain tumors7. In 1921, Dandy was the first neurosurgeon who successfully removed a colloid cyst from the third ventricle through a posterior transcallosal approach. Despite their unfavourable locations, these tumours can be removed successfully by proper knowledge of anatomical landmarks and by choosing the appropriate approach. Methods. We performed a retrospective analysis of all patients (17 patients) who underwent surgery for anterior third ventricular masses between March 2018 to March 2020 in the Dr Ram Manohar Lohia Institute of Medical Science Lucknow, Uttar Pradesh. Results: The most common symptom in our cases was headache, which was present in all (100%) patients, nausea/vomiting in 7 (41%), history of recurrent episodes of drop attacks in 4 (23%), h/o seizure in 2 (11.7%), visual disturbance in 1 (5.4%), memory disturbance in 1 (5.4%) and urinary incontinence in 1 (5.4%) patient. 6 patients were operated with transcallosal-transforaminal approach, 1 patient was operated with transcallosal interforniceal approach, 3 patients were operated with transcortical-transforaminal approach, 1 patient was operated with subfrontal translamina terminalis approach, 1 patient was operated with transcallosal-transchoroidal approach, 5 patients were operated with endoscopically. Gross total excision was achieved in 15 (88%) patients while in 2 (11.7%) patients subtotal resection was done due to their adherence to choroid plexus and optic chiasm. The most common post-operative complication was endocrine dysfunction in the form of diabetes insipidus. Conclusions. Anterior Third ventricular tumours are mostly benign and best treatment modality is surgical resection. When we analyzed the results of various approaches, we found that despite their unfavourable location, the results were satisfactory for different tumours of different location in the anterior third ventricle, when treated with the carefully planned microsurgical or endoscopic approach with proper knowledge of anatomical landmarks.

\"Balanced hyperosmolar therapy\" using 3% hypertonic saline - 20% mannitol versus an equiosmolar volume of either 3% hypertonic saline or mannitol 20% in supratentorial tumor resection: A new approach to achieve hemodynamic stability

2021 ◽  
Vol 8 (2) ◽  
pp. 221-229
Author(s):  
Samir A Elkafrawy ◽  
Mahmoud K Khames ◽  
Islam M Kandeel
Keyword(s):  
Hypertonic Saline ◽  
Urine Output ◽  
Fluid Intake ◽  
Tumor Resection ◽  
Double Blind Study ◽  
Hemodynamic Stability ◽  
Hyperosmolar Therapy ◽  
Significant Difference ◽  
Brain Relaxation ◽  
The Brain

Both 3% hypertonic saline (3% HTS) and 20% mannitol were proven to be effective in relaxing the brain during supratentorial surgeries. This work aimed to study the effect of consecutive use of both drugs on the brain relaxation score and hemodynamic status during such surgeries.Ninety patients scheduled for supratentorial brain surgeries included in this prospective, randomized and double-blind study. Patients were allocated in three groups; HTS group (n=30) received 3 ml/kg 3% NaCl infusion over 30 minutes, HTS/M group (n=30) received mannitol 20% (1.4 ml/kg) as an infusion over 15 minute followed by 1.5 ml/kg 3% NaCl infused over 15 minutes and M group (n=30) received 3.2 ml/kg mannitol 20% infusion over 30 minutes. Brain relaxation was estimated. MAP and serum Na level were recorded at baseline and then at 30, 90 and 150 min. Total fluid intake, total urine output and operative time were recorded. Fluid intake and urine output were the highest with 20% mannitol (p ˂ 0.001). HTS/M and HTS groups showed no significance when satisfactory and fairly brain relaxation scores were added (p=0.862). MAP and CVP were near to baseline in HTS/M group at 30 and 90 min, while at 150 min no significant difference between groups. Serum hyperosmolarity was noticed in all groups at all check points but maximally with HTS group at 30 min (321.1 mOsm/L). Balanced hyperosmolar therapy using 3% HTS and 20% mannitol consecutively resulted in a satisfactory brain relaxation and allowed more hemodynamic stability.

Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

2021 ◽  
pp. 1-12
Author(s):  
Arianna Fava ◽  
Paolo di Russo ◽  
Valentina Tardivo ◽  
Thibault Passeri ◽  
Breno Câmara ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Case Series ◽  
Craniocervical Junction ◽  
Anatomical Landmarks ◽  
Total Resection ◽  
Female Ratio ◽  
Cadaveric Dissection ◽  
Transcondylar Approach ◽  
Far Lateral

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

Intraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas

1993 ◽  
Vol 78 (6) ◽  
pp. 891-902 ◽  
Author(s):  
Webster H. Pilcher ◽  
Daniel L. Silbergeld ◽  
Mitchel S. Berger ◽  
George A. Ojemann
Keyword(s):  
Tumor Recurrence ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Seizure Outcome ◽  
Clear Trend ◽  
Content Type ◽  
Functional Brain Mapping ◽  
Intractable Seizures ◽  
Neuropsychological Assessments ◽  
Subtotal Removal

✓ Gangliogliomas are indolent neoplasms that are often associated with long-standing intractable seizures. The seizure-free outcome following ganglioglioma resection alone (or “lesionectomy”) has been generally favorable, ranging in most series from 50% to 65%. Thus, the value of resection of epileptogenic cortex in addition to tumor with regard to seizure outcome has been the subject of controversy. The authors describe a series of 12 patients with frontal or temporal lobe gangliogliomas associated with long-standing intractable seizures. In these patients, intraoperative electrocorticography was used to guide the resection of epileptogenic cortex along with tumor. Functional brain mapping, interictal and ictal monitoring of seizures, as well as thorough neuropsychological assessments were performed prior to resection in all cases. Outcome with regard to seizures, tumor recurrence, and neurological deficits was assessed with a mean follow-up period of 3.1 years. There was universal freedom from seizures postoperatively in 11 patients in whom complete or near-complete resection of epileptogenic cortex was achieved. In one patient in whom complete tumor resection and subtotal removal of epileptogenic cortex was achieved, a 95% reduction in seizure frequency was identified. No tumor recurrence or neurological deficits were observed. In a subset of four patients, neuropsychological and cognitive function were evaluated pre- and postoperatively. In these four, a clear trend toward improvement was noted in most functions. Thus, resection of epileptogenic cortex along with tumor may improve seizure outcome in selected patients with tumor-associated epilepsy without engendering identifiable neurological or cognitive deficits attributable to the incremental resection.

scholarly journals Progressive myeloneuropathy with symptomatic anaemia

2019 ◽  
Vol 12 (12) ◽  
pp. e230025 ◽  
Author(s):  
Charlene L Rohm ◽  
Sara Acree ◽  
Louis Lovett
Keyword(s):  
Bone Marrow ◽  
Delayed Diagnosis ◽  
Serum Vitamin ◽  
Neurological Impairment ◽  
Serum Copper ◽  
Normal Serum ◽  
Neurological Deficits ◽  
Caucasian Woman ◽  
Symptomatic Anaemia ◽  
Unnecessary Procedures

Hypocupremia is a rare and under-recognised cause of bone marrow dysplasia and myeloneuropathy. A 47-year-old Caucasian woman had progressive ascending peripheral neuropathy and gait ataxia over 3 months and fatigue, dyspnoea and unintentional weight loss over 8 months. She had profound macrocytic anaemia and neutropenia. Initial workup included normal serum vitamin B12. Bone marrow biopsy was suggestive of copper deficiency. Serum copper levels were later confirmed to be undetectable. The patient received oral copper repletion which resulted in complete normalisation of haematological abnormalities 16 weeks later. However, neurological deficits persisted. This case describes a delayed diagnosis of hypocupremia as initially suggested through invasive testing. Associating myeloneuropathy with cytopenia is imperative for accurate and prompt diagnosis of hypocupremia, which can be confirmed by serum analysis alone. Developing an accurate differential diagnosis can help prevent unnecessary procedures. Furthermore, initiating prompt copper repletion prevents further neurological impairment. Neurological deficits are often irreversible.

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