Abstract
The transcallosal approach is indicated for craniopharyngiomas that are primarily located in the third ventricle cavity with a significant expansion into the superior-posterior part of the ventricular cavity. Relationship with the third ventricle floor should be identified preoperatively. In some cases craniopharyngiomas displace upward the roof of the ventricle. These tumors are basically those described as type IV in the Kassam classification based on the tumor growth and the position of the infundibulum [1]. In other cases tumor grows primarily inside the third ventricle cavity, displacing downward the hypothalamus. Tumors can be dissected through both foramina of Monro even if, in some cases, a subchoroidal or interforniceal route may help in the dissection of the posterior pole of the tumor. The interforniceal route carries the risk of bilateral fornices’ damage with devastating neurologic consequences for memory and cognitive postoperative performances. In case of a cystic cavum pellucidum, the so-called cavum vergae, this anatomical variation produces itself a corridor between fornices to access the roof of the third ventricle without adjunctive neural splitting and, thus, providing enough space for a safe and effective dissection and tumor removal. Hydrocephalus is not a prerequisite for the transcallosal route, while it is mandatory for the transcortical approach. Lesions involving supra- and parasellar cisterns are not resectable by the transcallosal route. If the tumor has a significant portion into the parasellar cisterns, a translamina-terminalis approach through an anterolateral (pterional) or anterior (frontal mono- or bilateral) craniotomy should be considered to resect this portion and its eventual extension into the anterior portion of the third ventricle. A combined translamina-terminalis and transcallosal approach may be indicated for craniopharyngiomas extending into the supra- and parasellar lesion with a significant portion reaching the middle and superior portion of third ventricle cavity [2].
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Angileri, F.F., Granata, F., Tomasello, F. (2016). Transcallosal Approach. In: Cappabianca, P., Cavallo, L., de Divitiis, O., Esposito, F. (eds) Midline Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21533-4_13
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