Romanian Neurosurgery (Jun 2022)
Invasive tumours of third ventricle
Abstract
Despite the rapid development of neurosurgery in the 21st century, the invasive (secondary) tumours of the third ventricle have always presented a highly sophisticated challenge in terms of surgical treatment. The question of radical resection of these tumours remains debatable, considering the high risk associated with the possibility of disability, the expected duration and the postoperative quality of life. We conducted a retrospective study of patients with invasive third ventricular tumours that have been treated in our department from 2015 to 2020 reviewing pre-and postoperative clinical and radiological data for 21 cases. The treatment options in all 21 cases included an endoscopic frontal transcortical transventricular transforaminal-transchoroidal tumour removal, achieving gross total and subtotal resection in 86% of the interventions, followed by adjuvant treatment (radiation therapy in all cases, and chemotherapy – for high-grade tumours). An endoscopic third ventriculocisternostomy was performed in cases with partial tumour removal in order to improve the CSF flow. Neurological deficits included permanent hemiplegia – in 3 patients (15%), permanent hemianopia – in 2 patients (10%), transient short-term memory impairment – in 3 patients (15%) with regression in 2-4 weeks after surgery. There was no postoperative lethality. Maximal postoperative survival in our patients with high-grade tumours was 16 months; patients with low-grade tumours are still under supervision. Endoscopic frontal transcortical transventricular transforaminal-transchoroidal approach to resection of third ventricular tumours is an effective surgical modality, that maximizes the possible resection volume with minimal occurrence of postoperative complications, therefore can be recommended for the routine treatment of the aforementioned pathology.
