Abstract
The aim of this study is to review the results and clinical outcome of patients with surgically treated lesions within the trigone of the lateral ventricle. This is a retrospective case series of 20 (eight male, 12 female) patients with lesions of the trigone of the lateral ventricle operated between 1998 and 2008. All lesions were removed via the transcortical temporal and transcortical parietal route. Surgical complications and outcome were assessed using the modified Rankin Scale (mRS). There were four children and 16 adults with a mean age of 42 ± 22 years (min = 1, max = 74). Eight (40%) lesions grew within the trigone of the dominant hemisphere. In 17 cases, the lesion was purely intraventricular, and in three cases, a slight paraventricular extension was seen. The mean size was 4.5 cm of maximal diameter. Surgical removal was achieved via the transcortical parietal route in 13 cases (65%) and the transcortical temporal route in seven cases (35%). In all cases, complete resection was possible. According to the mRS, 13 patients improved, five remained the same, and two were lost to follow-up. One patient had an increased visual field deficit postoperatively and new hemiparesis and aphasia, but returned to the preoperative level within a few weeks. In one patient, an acute myocardial infarction occurred due to previous cardiac stent placement and in-stent stenosis. Even large trigonal lesions can be resected with low morbidity using a transcortical approach depending on the peritrigonal extension of the tumor.
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Christopher Nimsky, Marburg, Germany
Lesions in the trigonal region require a profound anatomical knowledge to decide the optimal surgical approach to avoid neurological sequelae. All patients were either operated on a transcortical temporal or transcortical parietal approach; postoperative neurological deficits were low. The series of 20 patients spans a long period of 10 years, so that the influence of modern navigation techniques cannot be estimated. It will be interesting to see in the future on whether the application of sophisticated navigation techniques allowing the identification of eloquent cortical and subcortical brain structures, such as the speech areas and pathways, as well as the optic radiation, will further influence the decision making on the optimal approach and, at all, be able to further improve the good neurological outcome.
Dietmar Krex, Dresden, Germany
This is a carefully elaborated series of tumors located in the trigonal and peritrigonal region of the lateral ventricle which have been operated by two different approaches. Those less frequent lesions are associated with potential risks to harm the visual tract, the precentral gyrus, the thalamus, the vascular supply of the choroidal arteries and the deep venous system, the speech and angular region in the dominant hemisphere and the corpus callosum depending on the approach. The authors present their good results by either using the transcortical temporal or transcortical parietal route, respectively. In addition, alternative routes are described and discussed leading to one important message of the paper. Those deep-seated and frequently large lesions should not be underestimated. Of course, the presented two routes are not the solution for every situation and the decision will be affected also by personal experience, but in any case, an individual, thoroughly tailored approach is mandatory to avoid the above mentioned sequelae. This is important to remember just for those lesions which do not occur on a daily basis.
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Juretschke, F.R., Güresir, E., Marquardt, G. et al. Trigonal and peritrigonal lesions of the lateral ventricle—surgical considerations and outcome analysis of 20 patients. Neurosurg Rev 33, 457–464 (2010). https://doi.org/10.1007/s10143-010-0271-8
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DOI: https://doi.org/10.1007/s10143-010-0271-8