Although the treatment of colloid cysts remains controversial, high viscosity and small volume are poor prognostic indicators for successful burr hole aspiration and cortical incision via craniotomy may be associated with postoperative epilepsy. The anterior transcallosal approach provides a direct and adequate pathway to the lateral ventricles, where the foramen of Monro serves as a natural entrance into the anterior third ventricle, especially when the foramen is dilated by a lesion. When the midsuperior portion of the IIIrd ventricle cannot be reached, the interforniceal or the subchoroidal exposures have been advocated. Stereotactic techniques contribute to a minimal invasive approach and reduce morbidity. Nine patients harbouring anterior third ventricular cysts (seven colloids and two intrinsic craniopharyngiomas) underwent anterior transcallosal microsurgical excision assisted by an interactive infrared-based image guided system (EasyGuide, Neuro, Philips). There were 4 men and 5 women ranging in age from 15 to 42 years (mean 28.5). Transcallosal transforaminal (5 cases) or interforniceal (4 cases) approaches allowed total excision in eight patients and subtotal in one. Postoperative morbidity included a case of transient hemiparesis and a case of transient short-term memory disturbances; both resolved in the first months. Mortality was zero. Particular advantages of the method were accurate trajectory and position of callosotomy incision determination, visualisation and avoidance of superior saggital sinus, retraction of bridging veins and the often variable pericallosal arteries, spatial orientation within the ventricular system, and identification of the periventricular anatomical structures.
Key words:
Neuronavigation - Transcallosal - Third Ventricle - Colloid Cyst
References
-
1
Kondziolka D, Lunsford L D.
Stereotactic management of colloid cysts; factors predicting success.
J Neurosurg.
1991;
75
45-51
-
2
Camacho A, Abernathey C D, Kelly P J, Laws E R.
Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography.
Neurosurgery.
1989;
24
693-700
-
3
Shucart W A, Stein B M.
Transcallosal approach to the anterior ventricular system.
Neurosurgery.
1978;
3
339-343
-
4
Wadley J, Kitchen N, Thomas D.
Image-guided neurosurgery.
Hosp Med.
1999 Jan;
60 (1)
34-38
-
5 Wadley J P, Dorward N L, Breeuwer M, Kitchen N D, Thomas D GT. Neuronavigation in 210 cases: further development of applications and full intergration into contemporary neurosurgical practice. In: Lemke HU, Vannier MW, Inamura K (eds). Computer Assisted Radiology and Surgery Amsterdam: Elsevier Science 1998: 627-634
-
6
Ture U, Yasargil M G, Al-Mefty O.
The transcallosal-transforaminal approach to the third ventricle with regard to the venous variations in this region.
J Neurosurg.
1997;
87
706-715
-
7 Apuzzo M L, Giannotta S L. Transcallosal interforniceal approach. In: Apuzzo MLJ (ed). Surgery of the Third Ventricle Baltimore: Williams & Wilkins 1997: 354-380
-
8
Antunes J L, Louis K M, Ganti S R.
Colloid cysts of the third ventricle.
Neurosurgery.
1980;
7
450-455
-
9
Abdou M S, Cohen A R.
Endoscopic treatment of colloid cysts of the third ventricle. Technical note and review of the literature.
J Neurosurg.
1998;
89
1062-1068
-
10
Cabbell K L, Ross D A.
Stereotactic microsurgical craniotomy for the treatment of third ventricular colloid cysts.
Neurosurgery.
1996;
38
301-307
-
11
Kondziolka D, Lunsford L D.
Microsurgical resection of colloid cysts using a stereotactic transventricular approach.
Surg Neurol.
1996;
46
485-492
-
12
Morita A, Kelly P J.
Resection of intraventricular tumors via a computer-assisted volumetric stereotactic approach.
Neurosurgery.
1993;
32
920-927
-
13
Konovalov A N, Gorelyshev S K.
Surgical treatment of anterior third ventricle tumours.
Acta Neurochir (Wien).
1992;
118
33-39
-
14
Long D M, Chou S N.
Transcallosal removal of craniopharyngiomas within the third ventricle.
J Neurosurg.
1973;
39
563-567
-
15
Winkler P A, Weis S, Buttner A, Raabe A, Amiridze N, Reulen H J.
The transcallosal interforniceal approach to the third ventricle: Anatomic and microsurgical aspects.
Neurosurgery.
1997;
40
973-982
-
16
Woiciechowsky C, Vogel S, Lehmann R, Staudt J.
Transcallosal removal of lesions affecting the third ventricle: an anatomic and clinical study.
Neurosurgery.
1995;
36
117-123
-
17
Dorward N L, Alberti O, Velani B, Gerritsen F A, Harkness W F, Kitchen N D, Thomas D G.
Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation.
J Neurosurg.
1998 Apr;
88 (4)
656-662
Corresponding Author
T. S. Paleologos,M. D.
Consultant Neurosurgeon
149 Olgas street
16561 Athens
Greece
Telefon: +30-1-9646723
eMail: theopal@atenet.gr
