Microsurgical removal of large neoplasms located in the suprasellar, back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach / 中华神经医学杂志

ABSTRACT

Objective To summarize the microsurgical techniques for removal of large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach.Methods Fifty-six patients with large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle,admitted to our hospital from January 2002 to January 2013 and performed removal via bilateral frontobasal interhemispheric approach; their clinical data and treatment efficacy were analyzed retrospectively.The microsurgical techniques were summarized,and the factors affecting the prognosis were analyzed.Results Total removal of the tumors was achieved in 49 patients (88％) and subtotal removal in 7 (12％).The pituitary stalk was reserved in 47 patients (84％),severed in 4 (7％),and unidentified in 5 (9％).The bilateral olfactory nerves were successfully preserved in 50 patients (89％) and unilateral severed in 6 (11％).Visual impairment was found in 41 patients before surgery,39 of them achieved postoperative visual improvement and 2 patients had no change during the follow-up at 6 months.In our series,there were no procedure-related mortalities and bacterial meningitis.Unilateral anosmia was detected on examination in 2 patients.Minimal frontal lobe contusion developed in 2 patients but resolved within 3 weeks.Cerebrospinal fluid leakage occurred in 1 patient,which was cured for 2 week.Transient diabetus insipidus developed in 25 patients but resolved within 1 month; permanent postoperative diabetes insipidus was present in 5 patients during the follow-up at 6 months.During the follow-up of 12 months,56 patients (100％) gained Glasgow outcome scale (GOS) scores of 5,only 4 (7％) patients with tumors resected partially had tumor relapse and received surgery again.Conclusions The bilateral frontobasal interhemispheric approach is appropriate for removing tumors located in the suprasellar,back of sellar region and anterior part of third ventricle.With sufficient exposure of lesion,the important anatomic structures such as the pituitary stalk,hypothalamic structure,perforating vessels,anterior communicating complex,the visual pathway,and the olfactory nerves could be preserved effectively.The surgery via this approach can increase total removal rate of the tumors,decrease the complications and achieve a good outcome.