Abstract
Background
Surgical treatment of large exophytic chiasmatic/hypothalamic astrocytomas extending into the anterior third ventricle remains a challenging task for neurosurgeons. In particular, when the tumor extends from the chiasmatic region upward to the foramen of Monro, damage to the fornix and other neurovascular structures is a major concern.
Objective
To describe the technique used in the transventricular preforniceal surgical approach to remove the superior and superoposterior part of the tumor in the third ventricle for treatment of exophytic chiasmatic/hypothalamic astrocytoma.
Methods
The transventricular preforniceal approach was used in two cases of exophytic chiasmatic/hypothalamic astrocytoma. The approach is summarized in 4 procedures: 1) exposure of the anterior horn of the lateral ventricle by the transcallosal approach, 2) identification of the foramen of Monro and the fornix, 3) incision of the septum pellucidum or the wall of the lateral ventricle, in front of the columns of the fornix, and 4) removal of the tumor through the space between the anterior commissure and the columns of the fornix.
Results
Because the tumor compressed the foramen of Monro posteriorly and stretched the space between the anterior commissure and the columns of the fornix, the posterosuperior part of the tumor in the third ventricle was successfully removed through the surgical corridor in front of the columns of the fornix. In both cases, tumors were successfully removed using this approach without damaging the fornix and the anterior commissure. Residual tumor was removed using an anterior interhemispheric translamina terminalis approach in a two-stage surgery.
Conclusions
The transventricular preforniceal approach can be applied for removing the superior part of exophytic chiasmatic/hypothalamic astrocytomas, because the space between the anterior commissure and the fornix is stretched by the tumor, providing an appropriate surgical corridor.
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References
Apuzzo ML, Chikovani OK, Gott PS, Teng EL, Zee CS, Giannotta SL, Weiss MH (1982) Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences. Neurosurgery 10:547–554
Apuzzo MLJ, Amar AP (1998) Transcallosal interforniceal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 421–452
Ehni G, Ehni BL (1998) Considerations in transforaminal entry. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 391–419
Feiz-Erfan I, Horn EM, Rekate HL, Spetzler RF, Ng YT, Rosenfeld JV, Kerrigan JF 3rd (2005) Surgical strategies for approaching hypothalamic hamartomas causing gelastic seizures in the pediatric population: transventricular compared with skull base approaches. J Neurosurg 103:325–332
Garvey M, Packer RJ (1996) An integrated approach to the treatment of chiasmatic-hypothalamic gliomas. J Neurooncol 28:167–183
Lavyne MH, Patterson RH (1998) The subchoroidal trans-velum interpositum approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 453–469
Massimi L, Tufo T, Di Rocco C (2007) Management of optic-hypothalamic gliomas in children: still a challenging problem. Expert Rev Anticancer Ther 7:1591–1610
Patterson RH (1998) The subfrontal transsphenoidal and trans-lamina terminalis approaches. In: Apuzzo ML (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 471–487
Rosenfeld JV, Freeman JL, Harvey AS (2004) Operative technique: the anterior transcallosal transseptal interforniceal approach to the third ventricle and resection of hypothalamic hamartomas. J Clin Neurosci 11:738–744
Rosenfeld JV, Harvey AS, Wrennall J, Zacharin M, Berkovic SF (2001) Transcallosal resection of hypothalamic hamartomas, with control of seizures, in children with gelastic epilepsy. Neurosurgery 48:108–118
Shucart W (1998) The anterior transcallosal and transcortical approaches. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 369–389
Siwanuwatn R, Deshmukh P, Feiz-Erfan I, Rekate HL, Zabramski JM, Spetzler RF, Rosenfeld JV (2005) Microsurgical anatomy of the transcallosal anterior interforniceal approach to the third ventricle. Neurosurgery 56:390–396, discussion 390–396
Suzuki J (1998) The bifrontal anterior interhemispheric approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 489–515
Tindall GT, Tindall SC, Krisht AF (1998) The pterional approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 519–539
Wait SD, Abla AA, Killory BD, Nakaji P, Rekate HL (2011) Surgical approaches to hypothalamic hamartomas. Neurosurg Focus 30:E2
Wen HT, Rhoton AL Jr, de Oliveira E (1998) Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery 42:1205–1217, discussion 1217–1209
Winkler PA, Ilmberger J, Krishnan KG, Reulen HJ (2000) Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results. Neurosurgery 46:879–888, discussion 888–890
Winkler PA, Weis S, Buttner A, Raabe A, Amiridze N, Reulen HJ (1997) The transcallosal interforniceal approach to the third ventricle: anatomic and microsurgical aspects. Neurosurgery 40:973–981, discussion 981–972
Winkler PA, Weis S, Wenger E, Herzog C, Dahl A, Reulen HJ (1999) Transcallosal approach to the third ventricle: normative morphometric data based on magnetic resonance imaging scans, with special reference to the fornix and forniceal insertion. Neurosurgery 45:309–317, discussion 317–309
Wisoff JH, Abbott R, Epstein F (1990) Surgical management of exophytic chiasmatic-hypothalamic tumors of childhood. J Neurosurg 73:661–667
Yasargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery 62:1029–1040, discussion 1040–1021
Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73:3–11
Yasargil MG, Ture U, Roth P (1998) A combined approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 541–552
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Yoshimoto, K., Shono, T., Matsukado, K. et al. The transventricular preforniceal approach for exophytic chiasmatic/hypothalamic astrocytomas extending into the anterior third ventricle. Acta Neurochir 155, 727–732 (2013). https://doi.org/10.1007/s00701-013-1642-z
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DOI: https://doi.org/10.1007/s00701-013-1642-z