Surgical treatment of anterior third ventricle tumours

Summary

A review is given on the operative management of anterior third ventricle tumours, with special emphasis on the selection of the approach, the postoperative results and complications. The review is based on our own experiences with 337 cases and 340 operations, among them 198 craniopharyngiomas, 80 gliomas, 23 colloid cysts, 11 ependymomas, and 25 others.

The tumours can be approached through the lamina terminals or transcallosally or using a combination of both of these approaches.

The approach through the lamina terminalis is useful only in rather small tumours, because it does not allow a sufficient revision of the upper and posterior third ventricle compartments.

For larger tumours the transcallosal approach is preferable. We have abandoned the approach through the anterior horn of the lateral ventricle, because it does not allow an equally good vision of both sides of the third ventricle.

In some of the craniopharyngioma cases it was necessary to combine the transcallosal and subfrontal approaches in order to achieve total or subtotal tumour resection.

In craniopharyngiomas total or subtotal tumour removal was possible in 66% of the children and 59% of the adult patients, with a mortality higher in adults (30%) than in children (18.5%).

The main causes of complications in craniopharyngiomas were acute disturbances of hypothalamic circulation and function, with water-electrolyte imbalance and other signs of diencephalic insufficiency. In glioma cases an additional important cause of complications has been haemorrhage into the remaining tumour parts.

Colloid cysts could be exstirpated without mortality, using the transcallosal approach.

Preconditions for improvement of results are: stricter selection of patients, proper choice of approach, excellent microsurgical technique and optimal intensive care. Also earlier diagnosis of the tumours would contribute much to better results.