Peculiarities of the third ventricle surgery in endoscopic frontal transcortical approach

Abstract

Goal. To analyze the results of surgical treatment patients with the third ventricular pathology.Objective. To improve methods of transchoroidal dissection. To make enough space for surgery of the third ventricle by expanding the foramen of Monro. To reduce the risk of surgical treatment in the pathology at the posterior compartment of the third ventricle.Materials and methods. The results of treatment of 27 patients with tumors and colloid cysts to the third ventricle were analyzed. In all 27 patients endoscopic frontal transcortical approach was performed. In 24 cases of them extended anterior choroidal dissection was performed (transchoroidal and transforaminal approach); in 3 cases — transcortical transforaminal approach (without choroidal dissection). In all case there was fully endoscopic removal (100 %).Results. Gross total resection was achieved in 14 cases, subtotal resection — in 13 cases. Karnofsky Performance Scale in the postoperative period demonstrated ≥ 70 points in all patients. Complications occurred in 4 patients (14.8 %). No postoperative mortality was observed.Conclusions. 1. Transcortical transforaminal approach can be used for the pathology in the anterior compartment of the third ventricle. 2. Transcortical transchoroidal approach can be performed for the pathology, which localized or spread into the posterior part of the third ventricle. 3. Anterior transchoroidal dissection can be combined with transforaminal approaches if the ventricular hydrocephalus is not much expressed, foramen of Monro is not much enlarged to complete transforaminal procedure as well as when the tumor spreads to the posterior compartment of the third ventricle. 4. The number of complications related to the frontal transcortical transventricular approach in our series is 14.8 %, and they had transient nature and relapsed within a month postop; no postoperative mortality.