Supraorbital subfrontal trans-laminar endoscope-assisted approach for tumors of the posterior third ventricle
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Different surgical approaches have been developed for dealing with third ventricle lesions, all aimed at obtaining a safe removal minimizing brain manipulation. The supraorbital subfrontal trans-lamina terminalis route, commonly employed only for the anterior third ventricle, could represent, in selected cases with endoscopic assistance, an alternative approach to posterior third ventricular lesions.
Seven patients underwent a supraorbital subfrontal trans-laminar endoscope-assisted approach to posterior third ventricle tumors (two craniopharyngiomas, one papillary tumor of the pineal region, one pineocytoma, two neurocytomas, one glioblastoma). Moreover, a conventional third ventriculostomy was performed via the same trans-laminar approach in four cases.
Complete tumor removal was accomplished in four cases, subtotal removal in two cases, and a simple biopsy in one case. Adjuvant radiotherapy and/or chemotherapy was administered, if required, on the basis of the histologic diagnosis. No major complications occurred after surgery except for an intratumoral hemorrhage in a patient undergoing a biopsy for a glioblastoma, which simply delayed the beginning of adjuvant radiochemotherapy. No ventriculoperitoneal shunt placement was needed in these patients at the most recent clinical and radiologic session (average 39.57 months, range 13–85 months). Two illustrative cases are presented.
The supraorbital subfrontal trans-laminar endoscope-assisted approach may provide, in selected cases, an efficient and safe route for dealing with posterior third ventricular tumors.
KeywordsEndoscopic assistance Key-hole approach Minimally invasive surgery Posterior third ventricle tumor Supraorbital subfrontal approach Trans-lamina terminalis
- 5.Chibbaro S, Di Rocco F, Makiese O et al (2012) Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 35(3):331-338-340Google Scholar
- 8.Colasanti R, Tailor A-RA, Lamki T, Zhang J, Ammirati M (2015) Maximizing the petroclival region exposure via a suboccipital retrosigmoid approach: where is the intrapetrous internal carotid artery? Neurosurgery 11(Suppl 2):329-336-337Google Scholar
- 11.Dandy WE (1921) An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113–119Google Scholar
- 12.Dandy WE (1933) Benign tumors in the third ventricle of the brain: diagnosis and treatment. Charles C Thomas, SpringfieldGoogle Scholar
- 13.de Divitiis O, Angileri FF, d’Avella D, Tschabitscher M, Tomasello F (2002) Microsurgical anatomic features of the lamina terminalis. Neurosurgery 50(3):563-569-570Google Scholar
- 15.Figueiredo EG, Deshmukh V, Nakaji P, Deshmukh P, Crusius MU, Crawford N, Spetzler RF, Preul MC (2006) An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 59(4 Suppl 2):ONS212-220; discussion ONS220Google Scholar
- 16.Iacoangeli M, Di Rienzo A, Colasanti R, et al. Endoscopic transnasal odontoidectomy with anterior C1 arch preservation and anterior vertebral column reconstruction in patients with irreducible bulbomedullary compression by complex craniovertebral junction abnormalities: operative nuance. Neurosurgery. doi:10.1227/NEU.0000000000001330
- 18.Iacoangeli M, Di Rienzo A, Nocchi N, Balercia P, Lupi E, Regnicolo L, Di Somma LGM, Alvaro L, Scerrati M (2015) Piezosurgery as a further technical adjunct in minimally invasive supraorbital keyhole approach and lateral orbitotomy. J Neurol Surg A Cent Eur Neurosurg 76(2):112–118PubMedGoogle Scholar
- 19.Iacoangeli M, Di Rienzo A, Re M, Alvaro L, Nocchi N, Gladi M, De Nicola M, Scerrati M (2013) Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture. Cancer Manag Res 5:21–24CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Krishna V, Blaker B, Kosnik L, Patel S, Vandergrift W (2011) Trans-lamina terminalis approach to third ventricle using supraorbital craniotomy: technique description and literature review for outcome comparison with anterior, lateral and trans-sphenoidal corridors. Minim Invasive Neurosurg 54(5–6):236–242PubMedGoogle Scholar
- 25.Lan Q, Dong J, Huang Q (2006) Minimally invasive keyhole approaches for removal of tumors of the third ventricle. Chin Med J (Engl) 119(17):1444–1450Google Scholar
- 27.Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57(4 Suppl):242-255-255Google Scholar
- 32.Yaşargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery 62(6 Suppl 3):1029-1040-1041Google Scholar