RESUMO
BACKGROUND: The management of lateral ventricle tumors requires a balance between maximizing safe resection and preserving neurological function. METHOD: The authors present a successful case of a left lateral ventricular central neurocytoma resection. The trans-superior frontal sulcus approach was employed, providing a safe corridor while minimizing damage to the surrounding neuroanatomy. The use of an endoscope further facilitated the procedure, enabling the confirmation of complete tumor removal and the preservation of deep venous drainage and periventricular structures. CONCLUSION: This case highlights the utility of the trans-sulcal approach and the benefits of endoscopic assistance in the management of lateral ventricle tumors.
Assuntos
Neoplasias do Ventrículo Cerebral , Neurocitoma , Humanos , Neurocitoma/cirurgia , Neurocitoma/patologia , Neurocitoma/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/cirurgia , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Ventrículos Laterais/cirurgia , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/patologia , Procedimentos Neurocirúrgicos/métodos , Masculino , Adulto , Feminino , Resultado do TratamentoRESUMO
The complications anticipated in the postoperative period after surgical resection of lateral ventricular neoplasms (LVN) are hemorrhage, hydrocephalus. At the N.N. Burdenko Neurosurgery Center, 48 patients with LVN underwent surgical resection. We focused on the correlation between approaches to the ventricular system on one hand and the extent of resection and incidence of complications on the other based on anatomical and perfusion characteristics estimated via preoperative magnetic resonance imaging (MRI) with arterial spin labeling perfusion. By eliminating the surgical approach as a potential risk factor, we were able to demonstrate the correlation between the frequency of postoperative hemorrhage, the Evans index value, patient's gender, tumor blood flow (nTBF) and the location of the mass in the anterior horn of the lateral ventricle. The risk of hemorrhage depends on the patient's gender, presence of hydrocephalus, location of the mass and tumor blood flow values. The risk increases along with increase in Evance index and nTBF values.
Assuntos
Neoplasias do Ventrículo Cerebral , Hidrocefalia , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Neoplasias do Ventrículo Cerebral/cirurgia , Adulto , Idoso , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Ventrículos Laterais/cirurgia , Adolescente , Adulto Jovem , Estudos Retrospectivos , Criança , Hemorragia Pós-Operatória/epidemiologiaRESUMO
Intraventricular tumors of the lateral and third ventricles are relatively rare, accounting for 1-2% of all primary brain tumors in most large series [1-4]. They can be uniquely challenging to approach due to their deep location, propensity to become large before they are discovered, and association with hydrocephalus [5, 6]. The surgeon's goal is to develop a route to these deep lesions that will cause the least morbidity, provide adequate working space, and achieve a complete resection. This must be performed with minimal manipulation of the neural structures encircling the ventricles, avoiding functional cortical areas, and acquiring early control of feeding vessels [7, 8].
Assuntos
Neoplasias do Ventrículo Cerebral , Humanos , Neoplasias do Ventrículo Cerebral/cirurgia , Neoplasias do Ventrículo Cerebral/patologia , Ventrículos Cerebrais/cirurgia , Corpo Caloso/cirurgia , Hidrocefalia/cirurgia , Ventrículos Laterais/cirurgia , Procedimentos Neurocirúrgicos/métodosRESUMO
Ventricular puncture is a basic procedure that neurosurgeons learn in the early stages of their careers and is also performed in ventricular drainage and neuroendoscopic surgery. However, few neurosurgeons are confident in their ability to insert and place a ventricular catheter in the optimal position for ventriculoperitoneal(VP)shunting in a single pass. Even experienced neurosurgical consultants confident in difficult microsurgical procedures are uncomfortable with ventricular catheter placement in VP shunting. Moreover, many neurosurgeons believe that they will never perform a ventricular puncture from the posterior horn of the lateral ventricles. The reason for thinking that ventricular puncture via the anterior horn is safer and more accurate compared with the posterior approach is because the anterior approach can use facial landmarks such as eyes, nose, and ears. However, even with the anterior approach in VP shunting, it is more difficult than with ventricular drainage or neuroendoscopic surgery to achieve accurate placement owing to head rotation, and the success rate has been reported to be as high as 50%. In this article, I introduced "fool proof," which uses preoperative simulation to place a ventricular catheter in the optimal position according to the size and shape of each patient's head and ventricles. The first choice for VP shunting is the right parieto-occipital approach with a posterior horn puncture from Frazier's Point and, for L-P shunting, a paramedian puncture from the 2/3 or 3/4 lumbar interspace.
Assuntos
Hidrocefalia , Derivação Ventriculoperitoneal , Humanos , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos , Ventrículos Laterais/cirurgia , NeurocirurgiõesRESUMO
Patients who present with a large colloid cyst (CC) and nondilated ventricles represent a therapeutic challenge.1-3 Although transcallosal approaches provide reliable access to the lateral ventricle and foramen of Monro, direct visualization of the vascular attachment of the CC to the roof of the third ventricle is not always possible. This can be especially true with CCs located more posteriorly and superiorly.4 Opening of the choroidal fissure can improve access and visualization to the posterior third ventricle; however, this maneuver is associated with some element of risk.5 There is a paucity of operative video in the literature illustrating the technique of gentle, microblade elevation of the fornix to improve visualization into the third ventricle and, on occasion, avoid the need to open the choroidal fissure.6 We report the case of a 28-year-old woman who presented with headaches and progressive short-term memory dysfunction (Video 1). Magnetic resonance imaging demonstrated a 17-mm CC associated with distortion and thinning of the bilateral fornices without hydrocephalus. The patient was offered interhemispheric, transcallosal resection. Intraoperatively, gentle elevation of the fornix with a microblade retractor facilitated access to the vascular attachment of the colloid cyst-obviating the need to open the choroidal fissure. The index operative video discusses the technical nuances associated with trans-callosal resection of CC with use of the microblade retractor. Special emphasis is placed on the intricate relationship of neighboring anatomic structures. The patient consented to the procedure and the publication of her image.
Assuntos
Cistos Coloides , Terceiro Ventrículo , Humanos , Feminino , Adulto , Cistos Coloides/diagnóstico por imagem , Cistos Coloides/cirurgia , Cistos Coloides/patologia , Terceiro Ventrículo/cirurgia , Ventrículos Laterais/cirurgia , Procedimentos Neurocirúrgicos/métodos , MicrocirurgiaRESUMO
Although choroid plexus cysts are a frequent incidental neuroimaging finding, symptomatic ones are rare-a series of more than five cases are hard to find. In the absence of high-volume studies, there are no generally accepted algorithms for diagnosis and treatment for this pathology. Proposed surgical techniques include microsurgical excision or fenestration and endoscopic excision or fenestration with or without additional shunting. No definitive conclusions exist about the superiority of a certain technique. Here, we introduce an illustrative case of a patient with a symptomatic choroid plexus cyst in the trigone of the lateral ventricle and a systematic review of 65 additional published cases with the aim of identifying epidemiological features, variants of localization of the cysts, their symptoms, persistence of concomitant obstructive hydrocephalus, and treatment modalities. A PRISMA-based literature search was performed on the PubMed, MEDLINE, Scopus, and Web of Knowledge databases. We include in the review case reports and case series of symptomatic choroid plexus cysts with full texts or valuable abstracts available online in English and published by April 2023. All abstracts of retrieved studies were assessed by two independent researchers to avoid bias. Only descriptive statistics were used for the presentation of the results. A total of 48 studies (39 case reports and 9 case series) with 65 depicted cases met the eligibility criteria. The review showed a slight predominance of choroid plexus cysts in men. The most common localizations of cysts were the trigone and the body of the lateral ventricle. Obstructive hydrocephalus is often present in patients with choroid plexus cysts. The most common symptoms of cysts were signs of increased ICP: headaches and vomiting. The main treatment approaches for symptomatic choroid plexus cysts were microsurgical excision, microsurgical fenestration, endoscopic fenestration, and total endoscopic excision. The tendency has been noted to shift from microsurgical to endoscopic procedures over the past two decades. Some data on the classification of cysts of the central nervous system and the underlying mechanisms of the pathogenesis of choroid plexus cysts are also presented.Although symptomatic cases of choroid plexus cysts are rare, by summarizing currently available data, one could clarify their common features and identify a preferable treatment modality.
Assuntos
Cistos do Sistema Nervoso Central , Cistos , Hidrocefalia , Masculino , Humanos , Plexo Corióideo/cirurgia , Plexo Corióideo/patologia , Cistos do Sistema Nervoso Central/cirurgia , Cistos do Sistema Nervoso Central/patologia , Cistos/diagnóstico , Cistos/cirurgia , Cistos/patologia , Hidrocefalia/cirurgia , Hidrocefalia/complicações , Ventrículos Laterais/cirurgiaRESUMO
PURPOSE: To create a high-quality, cadaver-based, operatively oriented resource documenting the anterior transcortical and interhemispheric transcallosal approaches as corridors to the third ventricle targeted towards neurosurgical trainees at all levels. METHODS: Two formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Dissections of the transcortical and transcallosal craniotomies with transforaminal, transchoroidal, and interforniceal transventricular approaches were performed. The dissections were documented in a stepwise fashion using three-dimensional photographic image acquisition techniques and supplemented with representative cases to highlight pertinent surgical principles. RESULTS: The anterior transcortical and interhemispheric corridors afford excellent access to the anterior two-thirds of the third ventricle with varying risks associated with frontal lobe versus corpus callosum disruption, respectively. The transcortical approach offers a more direct, oblique view of the ipsilateral lateral ventricle, whereas the transcallosal approach readily establishes biventricular access through a paramedian corridor. Once inside the lateral ventricle, intraventricular angled endoscopy further enhances access to the extreme poles of the third ventricle from either open transcranial approach. Subsequent selection of either the transforaminal, transchoroidal, or interforniceal routes can be performed through either craniotomy and is ultimately dependent on individual deep venous anatomy, the epicenter of ventricular pathology, and the concomitant presence of hydrocephalus or embryologic cava. Key steps described include positioning and skin incision; scalp dissection; craniotomy flap elevation; durotomy; transcortical versus interhemispheric dissection with callosotomy; the aforementioned transventricular routes; and their relevant intraventricular landmarks. CONCLUSIONS: Approaches to the ventricular system for maximal safe resection of pediatric brain tumors are challenging to master yet represent foundational cranial surgical techniques. We present a comprehensive operatively oriented guide for neurosurgery residents that combines stepwise open and endoscopic cadaveric dissections with representative case studies to optimize familiarity with third ventricle approaches, mastery of relevant microsurgical anatomy, and preparation for operating room participation.
Assuntos
Neoplasias Encefálicas , Terceiro Ventrículo , Humanos , Criança , Terceiro Ventrículo/cirurgia , Terceiro Ventrículo/anatomia & histologia , Ventrículos Cerebrais/cirurgia , Ventrículos Cerebrais/anatomia & histologia , Procedimentos Neurocirúrgicos/métodos , Ventrículos Laterais/cirurgia , Neoplasias Encefálicas/cirurgia , Corpo Caloso/cirurgia , Corpo Caloso/anatomia & histologiaRESUMO
BACKGROUND: Glioblastoma is one of the most common and aggressive adult brain tumors. The conventional treatment strategy, surgery combined with chemoradiotherapy, did not change the fact that the recurrence rate was high and the survival rate was low. Over the years, accumulating evidence has shown that the subventricular zone has an important role in the recurrence and treatment resistance of glioblastoma. The human adult subventricular zone contains neural stem cells and glioma stem cells that are probably a part of reason for therapy resistance and recurrence of glioblastoma. MAIN BODY: Over the years, both bench and bedside evidences strongly support the view that the presence of neural stem cells and glioma stem cells in the subventricular zone may be the crucial factor of recurrence of glioblastoma after conventional therapy. It emphasizes the necessity to explore new therapy strategies with the aim to target subventricular zone to eradicate neural stem cells or glioma stem cells. In this review, we summarize the recent preclinical and clinical advances in targeting neural stem cells in the subventricular zone for glioblastoma treatment, and clarify the prospects and challenges in clinical application. CONCLUSIONS: Although there remain unresolved issues, current advances provide us with a lot of evidence that targeting the neural stem cells and glioma stem cells in subventricular zone may have the potential to solve the dilemma of glioblastoma recurrence and treatment resistance.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Células-Tronco Neurais , Adulto , Humanos , Ventrículos Laterais/patologia , Ventrículos Laterais/cirurgia , Glioblastoma/terapia , Glioblastoma/patologia , Células-Tronco Neurais/patologia , Neoplasias Encefálicas/terapia , Neoplasias Encefálicas/patologiaRESUMO
Background: Endoscopic surgery has emerged in recent years as an alternative to conventional microsurgical approaches for removal of intraventricular tumors. Endoports have enhanced tumor access and visualization with a significant reduction in brain retraction. Objective: To evaluate the safety and efficacy of endoport-assisted endoscopic technique for the removal of tumors from the lateral ventricle. Methods: The surgical technique, complications, and postoperative clinical outcomes were analyzed with a review of the literature. Results: Tumors were primarily located in one lateral ventricular cavity in all 26 patients, and extension to the foramen Monro and the anterior third ventricle was observed in seven and five patients, respectively. Except for three patients with small colloid cysts, all other tumors were larger than 2.5 cm. A gross total resection was performed in 18 (69%), subtotal in five (19%), and partial removal in three (11.5%) patients. Transient postoperative complications were observed in eight patients. Two patients required postoperative CSF shunting for symptomatic hydrocephalus. All patients improved on KPS scoring at a mean follow-up of 4.6 months. Conclusions: Endoport-assisted endoscopic technique is a safe, simple, and minimally invasive method to remove intraventricular tumors. Excellent outcomes comparable to other surgical approaches can be achieved with acceptable complications.
Assuntos
Neoplasias do Ventrículo Cerebral , Neuroendoscopia , Humanos , Neoplasias do Ventrículo Cerebral/cirurgia , Ventrículos Laterais/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodosRESUMO
INTRODUCTION: Choroidal fissure cysts (CFC) are usually an incidental finding on imaging and lead to morbidity only in rare cases. The aim of this study was to present the case of a patient with a giant CFC and its treatment. CASE REPORT: The patient was a male infant of 9 days of life that presented with symptoms of intracranial hypertension. A CFC measuring 56 × 70 × 86 mm was diagnosed. Endoscopic fenestration of the cyst was performed; however, the communication closed thereafter. A reservoir catheter was inserted, which subsequently became infected and was then replaced by a ventriculoperitoneal shunt. DISCUSSION: The choroidal fissure is a C-shaped cleft located between the fornix and the thalamus separated from the temporal horn by the layer of tela choroidea. The pathophysiology of CFC is still unclear. In our case, initial endoscopic treatment was decided on to avoid shunt-related complications. Currently, there are no guidelines for the best surgical treatment for CFC. CONCLUSION: We describe an atypical case of CFC and analyze the surgical treatment performed. Although endoscopic treatment is recommended for CFC, currently no guidelines exist regarding the best management of the entity.
Assuntos
Cistos Aracnóideos , Cistos , Lactente , Humanos , Masculino , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Ventrículos Laterais/cirurgia , Plexo Corióideo/cirurgia , Endoscopia/métodos , Derivação Ventriculoperitoneal , Cistos Aracnóideos/cirurgia , Imageamento por Ressonância MagnéticaRESUMO
Head injuries are often associated with intracranial foreign bodies that require decision making on the need for certain surgical treatment. Intraventricular foreign bodies are rare, so the question of surgical tactics is still open. OBJECTIVE: To summarize the experience of treating the wounded with intraventricular foreign bodies. MATERIAL AND METHODS: Treatment outcomes in victims with foreign bodies in lateral ventricles are presented. Searching in the e-Library, PubMed, Google Scholar databases included the following keywords: «penetrating wounds¼, «foreign bodies¼, «cerebral ventricles¼, «gunshot injury¼, «ventricular foreign bodies¼. We analyzed data on the treatment of victims with intraventricular foreign bodies. RESULTS: Three victims underwent surgery, and foreign bodies were removed from the occipital horn of the lateral ventricle, third ventricle and temporal horn of the lateral ventricle. Conservative approach was preferred in 1 case. Follow-up ranged from 1 month to 7 years, GOS score - 3-4 points. Disability was due to severe injury and not associated with surgical treatment per se. We found 16 publications matching the searching criteria. Treatment methods varied from standard surgical approaches to stereotactic management. The indication for removal of foreign bodies was their migration through the ventricular system and occlusive hydrocephalus. None patient had neurological aggravation. CONCLUSION: Intraventricular foreign bodies are rare and present certain difficulties in choosing the method and timing of treatment. Indications for their removal are migration, occlusive hydrocephalus and infectious complications. The method of removal is determined depending on location, magnetic properties, nature of injury, surgical preferences and other factors.
Assuntos
Corpos Estranhos , Hidrocefalia , Humanos , Ventrículos Cerebrais , Corpos Estranhos/cirurgia , Ventrículos Laterais/cirurgia , Resultado do Tratamento , Hidrocefalia/etiologiaRESUMO
BACKGROUND: An entrapped temporal horn (ETH) is one of the critical complications after tumor removal in the lateral ventricle trigone that sometimes becomes life threatening. OBJECTIVE: We sought to develop a novel intraoperative method of prophylactic intraventricular piping (PIP) just after tumor removal to prevent ETH. METHODS: Three patients with meningiomas in the lateral ventricle trigone were treated by a novel intraoperative method of PIP just after tumor removal to prevent ETH. Silicone catheters normally used as ventricular drainage catheters were cut to 5- to 6-cm length and inserted into the tumor cavity to ensure communication between the temporal horn and the atrium or the body of the lateral ventricle through the piping straddling the trigone. RESULTS: None of our patients developed ETH during the follow-up period without complications caused by the tube placement. CONCLUSIONS: PIP might be beneficial to prevent ETH because constant osmotic pressure and constant cerebrospinal fluid pulse wave transmission are maintained between each compartment of the lateral ventricle.
Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/patologia , Ventrículos Laterais/cirurgia , Ventrículos Laterais/patologia , Procedimentos Neurocirúrgicos , Lobo Temporal/patologia , Neoplasias Meníngeas/patologiaRESUMO
Secondary to the creation of a surgical corridor and retraction, white matter tracts degenerate, causing long-term scarring with potential neurological consequences. Third and lateral ventricle tumors require surgery that may lead to cognitive impairment. Our objective is to compare the long-term consequences of a transcortical transfrontal approach and an interhemispheric transcallosal approach on corpus callosum and frontal white matter tracts degeneration. Surgical patients with ventricular tumor accessible through both approaches were included and clinico-radiological data were retrospectively analyzed. The primary endpoint was the callosotomy length at 3-month post-operative T1 MRI, corrected by the extension of the tumor and the use of neuronavigation. Secondary outcomes included perioperative criteria such as bleeding, use of retractors and duration, FLAIR hypersignal on 3-month MRI, and re-do surgeries. To assess white matter tract interruption, 3-month FLAIR hypersignal was superposed to a tractography atlas. Seventy patients were included, 57 (81%) in the transfrontal group and 13 (19%) in the interhemispheric group. There was no difference in the mean callosotomy length on 3-month MRI (12.3 mm ± 5.60 transfrontal vs 11.7 mm ± 3.92 interhemispheric, p = 0.79) on univariate and multivariate analyses. The callosotomy length was inferior by - 3.13 mm for tumors located exclusively in the third ventricle (p = 0.016), independent of the approach. Retractors were used more often in transfrontal approaches (60% vs 33%, p < 0.001). The extent of frontal FLAIR hypersignal was higher after transfrontal approach (14.1 mm vs 0.525 mm, p < 0.001), correlated to the use of retractors (p < 0.05). After the interhemispheric approach, no tract other than corpus callosum was interrupted, whereas, after the transfrontal approach, frontal arcuate fibers and projections from the thalamus were interrupted in all patients, the cingulum in 19 (33%), the superior fronto-occipital fasciculus in 15 (26%), and the superior longitudinal fasciculus in 2 (3%). Transfrontal and interhemispheric approaches to the third and lateral ventricles both lead to the same long-term damage to the corpus callosum, but the transfrontal approach interrupts several white matter tracts essential to cognitive tasks such as attention and planning, even in the non-dominant hemisphere. These results encourage all neurosurgeons to be familiar with both approaches and favor the interhemispheric approach when both can give access to the tumor with a comparable risk. Neuropsychological studies are necessary to correlate these anatomical findings to cognitive outcomes.
Assuntos
Substância Branca , Humanos , Ventrículos Laterais/cirurgia , Imageamento por Ressonância Magnética , Neuronavegação , Estudos Retrospectivos , Substância Branca/patologia , Substância Branca/cirurgiaRESUMO
BACKGROUND: We present a case series of 7 patients with intraventricular arachnoid cysts of lateral ventricle managed with endoscopic treatment with proposed classification of the cyst based on anatomic extent. METHODS: In all patients, the lateral ventricle arachnoid cyst was primarily located in the trigone and body of the lateral ventricle. Proposed classification is based on extension of the arachnoid cyst. Type 1 is an arachnoid cyst located in the lateral ventricle only, type 2 is a lateral ventricle arachnoid cyst extending to the quadrigeminal cistern, and type 3 is the lateral ventricle arachnoid cyst extending to the velum interpositum cistern. RESULTS: Two patients were managed with multiple fenestration and septostomy, and in 1 patient where the cyst was not adherent to the ventricular wall it was excised completely. Two patients who had a lateral ventricle cyst located in the atrium but extending to quadrigeminal cyst were managed with 3 fenestrations. Two patients with a lateral ventricle arachnoid cyst located into the atrium of lateral ventricle and extending to the velum interpositum cistern through the choroid fissure were managed with 3 endoscopic fenestrations. Postoperatively, patients were followed clinically and by radiologic imaging. None of the patients reported recurrence until the latest follow-up. CONCLUSIONS: Multiple endoscopic fenestrations for lateral ventricle arachnoid cyst according to its location and anatomic extension help to reduce recurrence and good outcome. Cyst excision is recommended only when the cyst wall is easily separable from the lateral ventricle wall. Intraoperative use of thulium light amplification by stimulated emission of radiation helps in achieving early hemostasis and easy perforation of the thick cyst wall.
Assuntos
Cistos Aracnóideos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Ventrículos Cerebrais/cirurgia , Endoscopia , Humanos , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Imageamento por Ressonância MagnéticaAssuntos
Neoplasias Encefálicas , Glioblastoma , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Imageamento por Ressonância MagnéticaRESUMO
Infantile choroid plexus papilloma (CPP) associated with multiple peritumoral cysts is a rare variant of CPP, and clinical course and optimal management are largely unknown. A 9-month-old boy presented with a large solid tumor in the left lateral ventricle associated with multiple peritumoral cysts, arachnoid cysts, and hydrocephalus containing xanthochromic fluid with high protein content. Shrinkage of these cysts and resolution of hydrocephalus were achieved after total resection of the hypervascular solid part of the tumor. Histological examination confirmed the solid part of the tumor as CPP and showed that the wall of the peritumoral cysts consisted of reactive gliosis without neoplastic cells. Follow-up magnetic resonance imaging 12 months after surgery revealed that these cysts remained stable. CPP with nonenhancing peritumoral cysts can be managed by resection of only the solid part of the tumor without permanent cerebrospinal fluid diversion.
Assuntos
Cistos Aracnóideos , Neoplasias do Plexo Corióideo , Hidrocefalia , Papiloma do Plexo Corióideo , Cistos Aracnóideos/complicações , Plexo Corióideo/patologia , Neoplasias do Plexo Corióideo/complicações , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Neoplasias do Plexo Corióideo/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Lactente , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/patologia , Ventrículos Laterais/cirurgia , Imageamento por Ressonância Magnética , Masculino , Papiloma do Plexo Corióideo/complicações , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgiaRESUMO
The authors describe the clinical observation of a patient with a paraventricular tumor of the left frontal lobe and demonstrate the effectiveness of endoscopic biopsy of a volumetric mass of such localization through the lateral ventricle using intraoperative navigation. The disease manifested with convulsive seizures two years before the patient was admitted to the hospital. During this period of time, he was repeatedly examined. The dimensions of the volumetric formation remained unchanged. Based on the data obtained, it was not possible to accurately verify the type of tumor. Anticonvulsant therapy was ineffective. The patient underwent surgery - endoscopic partial removal of the tumor (biopsy) and opening of the tumor cyst through the left lateral ventricle using intraoperative navigation. Clinical improvement in the patient's condition was achieved. After the operation, the headaches and the seizures stopped.
Assuntos
Endoscopia , Ventrículos Laterais , Biópsia , Endoscopia/métodos , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Humanos , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Masculino , ConvulsõesAssuntos
Neoplasias do Ventrículo Cerebral , Cérebro , Glioma Subependimal , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/cirurgia , Glioma Subependimal/diagnóstico por imagem , Glioma Subependimal/cirurgia , Humanos , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Procedimentos Neurocirúrgicos/métodosRESUMO
The surgical approach to the atrium of the lateral ventricle remains a challenge because of its deep location and close relationship to important neurovascular structures. We present an alternative and safer approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. We demonstrate this approach through cadaveric anatomical microdissection and a case series. Five formalin-fixed brain specimens (10 hemispheres) were dissected with the Klingler technique. Transillumination was used to show the trajectory of the approach in cadaveric specimens. Clinical data from five patients who underwent this approach were reviewed. This data included intraoperative ultrasound images, operative images, pre- and postoperative magnetic resonance imaging, MR tractography, and visual field examination. The parieto-occipital fissure is a constant, uninterrupted fissure that can be easily identified in cadavers. Our anatomical dissection study revealed that the atrium of the lateral ventricle can be approached through the parieto-occipital fissure with minor damage to the short association fibers between the precuneus and cuneus, and a few fibers of the forceps major. In our series, five patients underwent total resection of their atrial lesions via the posterior interhemispheric transparieto-occipital fissure. No morbidity or mortality was observed, and the disruption of white matter was minimal, as indicated on postoperative tractography. The postoperative visual fields were normal. The posterior interhemispheric transparieto-occipital fissure approach is an alternative to remove lesions in the atrium of the lateral ventricle, causing the least damage to white matter tracts and preserving visual cortex and optic radiation.