Chordoid glioma of the third ventricle attached to the optic chiasm. Successful removal through a trans-lamina terminalis approach.

Chordoid glioma of the third ventricle constitutes a rare, very recently recognized histological entity. Most reports of this neoplasm, focused on its distinct histological features, have hypothesized about a probable origin of the lesion at the third ventricle floor and/or the lamina terminalis. We report on a new case, presenting neuroradiological and intraoperative pictorial evidences of the tumoral attachment, limited to the chiasm-lamina terminalis junction. A 53-year-old woman debuted with acute symptoms of obstructive hydrocephalus, visual disturbances and confusion. MRI investigation showed a large solid-cystic third ventricle mass bulging through the lamina terminalis and ventricular floor. After placing a ventriculoperitoneal shunt, the tumor was completely removed through a trans-lamina terminalis approach. A tight tumoral attachment to the junction of the posterior chiasm to the lamina terminalis was identified and dissected. No other adhesions to the third ventricle boundaries were found. A chordoid glioma was diagnosed on histological examination. One year after the surgical procedure the patient does not present new neurological deficits, and there are no signs of tumoral regrowth on the follow-up postoperative MRI. Chordoid glioma should be included in the differential diagnosis of third ventricle tumors. Preoperative neuroradiological suspicion of this lesion should alert the neurosurgeon about the presence of a tight tumoral adherence at the level of the chiasm-lamina terminalis junction. The trans-lamina terminalis approach provides a suitable route for an early control of this attachment under direct vision, allowing a safe dissection of the mass from the third ventricle.

Attention and memory in children with brain tumors.

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N = 18) and third ventricle tumors (N = 24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2-5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.

Transcallosal parafornicial approach for third ventricle tumors: neuropsychological consequences.

Five adult patients with 3rd ventricle tumors underwent a transcallosal intraventricular parafornicial approach. Pre- and postoperative cognitive reviews were conducted on all patients. Each review consisted of: a standardized neuropsychological battery, mental status reviews, specific tests for disconnection, and a personality variable, where possible. Computed tomography and magnetic resonance imaging are also presented. The three patients with colloid cysts and the two with oligodendrogliomas showed no significant postoperative cognitive deficits compared to the preoperative review. These additional subtle neuropsychometric measures, along with the methodological advantage of preoperative review, support a parafornicial approach where indicated to preserve cognitive abilities.

Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results.

OBJECTIVE: The present study was undertaken to describe the clinical and prospective neuropsychological results for our group of 30 patients who were treated using a transcallosal interforniceal-transforaminal microsurgical approach. METHODS: The transcallosal interforniceal and transcallosal-transforaminal approaches were used to treat 30 patients with space-occupying lesions located in the anterior part of the third ventricle. We used a modified anterior transcallosal microsurgical approach, as described recently. The patients underwent extensive, pre- and postoperative, prospective neuropsychological testing, using a specially designed test battery. RESULTS: Twenty-three of 30 patients (77%) experienced excellent clinical outcomes (Glasgow Outcome Scale Grade V). The surgical procedures described in this report did not themselves impair attentional function. In both the early and late postoperative neuropsychological testing sessions, deficits in verbal memory were only rarely observed and were not noted to be correlated with the surgical procedures. The most relevant neuropsychological results for individual patients are reported in detail. CONCLUSION: The approach described here can be successfully used for the resection of various space-occupying lesions in the anterior part of the third ventricle. The anatomic landmarks we recently defined and described (for example, the midline vessel on the trunk of the corpus callosum, to direct the callosotomy) guide the surgical path. Furthermore, we recommend the use of neuropsychological test batteries for both scientific and rehabilitative purposes.

Transcallosal approach to tumors of the third ventricle. Surgical results and neuropsychological evaluation.

A series of 34 patients with tumours of the third ventricle were operated on by a transcallosal route. Basal extrinsic lesions compressing or invading the ventricle as well as tumours located in the pineal area were excluded from this review. Tumours were approached by a transforaminal entry in 16 cases (47%), by an interforniceal route in 11 (32%), by a subchoroidal entry in 4 (14%) and by a combined transforaminal and subchoroidal entry in 3 (9%). Four out of 34 patients were submitted to a second operation, through the same approach corridor: 2 for an incomplete removal of an intrinsic tumour and 2 for a late regrowth. Postoperative mortality rate accounted for 5.8% (2 patients). Major post operative complications were hemiparesis (4 patients) and diabetes insipidus (4 patients), that were transient in 3. Akinetic mutism like status was observed in only 1 patient. Postoperative psychic disturbances were noticed in 5 cases. Nine out of 21 patients (62%) with preoperative hydrocephalus required a permanent CSF shunt. Histology revealed that 21 tumours (62%) were intraaxial (4 pilocitic astrocytoma, 10 low grade glioma, 1 giant cell astrocytoma, 1 subependymoma, 4 ependymoma/ependymoblastoma, 1 neurocitoma) and 13 (38%) were extraaxial (8 colloid cyst, 2 craniopharingioma, 1 ectopic pituitary adenoma, 1 lymphocytic hypophysitis and 1 metastasis). Total excision of third ventricle tumours was achieved in all patients with extraaxial tumours and in 62% and 71% of intraaxial tumours with the first and second surgical procedure respectively. Ten out of 34 patients of this series were submitted to a complete neuropsychological evaluation at an interval of 2-9 years after surgery. Memory tests were pathological in 2. Disconnection signs were constantly absent. Control function were preserved. Transcallosal approach remains the best microsurgical method of third ventricle tumours treatment. This route provides the capability for a superior visualization of the entire cavity of the third ventricle through different corridors. Permanent neurological and neuropsychological deficits are not frequent. Epilepsy, that accounted for 28% in patients submitted to transcortical transventricular approach to third ventricle tumours, was never noticed in this series operated on through a transcallosal route.

[Functional anatomy of the third ventricle. Neuropsychological data]. / Anatomie fonctionnelle du troisième ventricule. Données neuropsychologiques.

The functional structures surrounding the third ventricle explain the occurrence of neuropsychological disorders when a tumor develops in this area. The functional environment of the third ventricle is involved in memory, motor executive control, endocrine and vegetative regulations. The types of memory deficit, the behavioural and emotional regulations, the interhemispheric transfer, and the regulation of executive functions are analyzed and correlated to the concerned anatomical structures. The review of the literature collected few specific considerations in neuropsychological dysfunctions occurring with tumors of the third ventricle. A retrospective study was conducted in 17 patients of the national series operated on for a third ventricle lesion : long-term memory and executive functions were frequently impaired in the patients, and the deficits were underestimated by usual follow-up. More systematic utilization of preoperative and postoperative test batteries is necessary for a better evaluation of neuropsychological disorders after third ventricle surgery.

Acute vasospasm following transcallosal resection of a xanthogranulomatous colloid cyst of the 3rd ventricle.

We present the first case of a 57 year old man who developed severe, acute vasospasm following transcallosal resection of an unusual, xanthogranulomatous colloid cyst. The 16 year history of growth of this cyst may have resulted in its unusual pathology, and the subsequent vasospastic reaction to its excision. We discuss the potential pathological relationship between the inflammatory nature of the cyst, chemical meningitis and vasospasm, and what this implies about vasospasm in general. The severe, life-threatening vasospasm affected all four major vessels and required aggressive management by endovascular injection of nimodipine and angioplasty, with good recovery. The case illustrates a previously undescribed sequel of surgery for this condition, demonstrates an effective treatment and offers possible insights into the pathogenesis of vasospasm.

[The psychopathology of tumors of the 3rd cerebral ventricle]. / Psikhopatologiia opukholei III zheludochka mozga.

36 patients with tumors of diencephalic region of different histologic nature involving cavity of the third ventricle of the brain were observed. 27.7% of the patients had disorders of mental and physical development from the very first years of life. In presurgical period there was a wide spectrum of paroxysmal and permanent mental disorders from asthenia to rude disturbances of memory and consciousness which regressed or disappeared after the operation. The correlation was observed between such disorders, histologic structure and location of the tumor; individual characteristics of the patient (age, dextrality, sinistrality); scope and character of the operation (approach to the tumor, surgical interventions on the structures of the third ventricle).

Transcallosal approach to third ventricle tumor: case report. Partial removal of an infundibuloma (grade I astrocytoma arising from the floor of the third ventricle).

A care is described of an astrocytoma grade 1 arising from the floor of the third ventricle, operated upon transcallosally. No disconnection symptoms were produced. Five years later the patient has above normal intelligence and is attending school at normal grade level in spite of a CT scan suggesting recurrence of the tumor.

The interhemispheric transcallosal-transversal approach to the lesions of the anterior and middle third ventricle: surgical validity and neuropsychological evaluation of the outcome.

Based on the observation of the course of callosal fibres and of their artero-venous support as appearing in a microanatomic study, the Authors propose a variant of standard callosotomy procedure by the introduction of the transverse section of callosal fibres. This technique would allow the surgeon to spare a larger number of callosal fibres by the combined effect of a lower direct mechanical traction on fibres and a lower impact on artero-venous microcircle. The neuropsychological outcome of the patients who underwent this kind of procedure was evaluated. Fourteen patients affected by occupying-space lesions involving the anterior and middle third ventricle were included in the study. Ten patients underwent transverse callosotomy, four subjects received standard sagittal callosotomy. A control group was also included in the study. All patients underwent a pre-operative and six months post-operative neuropsychological evaluation focused on performance at cognitive and attentional tasks. No disturbances in executive function were observed in either group. Patients receiving transverse callosotomy performed as well as control group subjects in attentive tasks, which is not the case of patients undergoing sagittal callosotomy who show a marked deficit in selective attention for left side visual field. The observed more favourable neuropsychological outcome supports transverse callosotomy as a valid alternative method to standard longitudinal callosotomy in third ventricle surgery.

[The early postoperative period in patients with tumors of the posterior cranial fossa]. / Rannii posleoperatsionnyi period u bol'nykh s opukholiami zadnei cherepnoi iamki.

The studies carried out during an early postoperative period in patients with posterior fossa tumors were made to analyse the role of the degree and the level of brain stem damages in formation of cerebral reactions. The three groups of cases were selected in accordance with the course of the postoperative period: 1.1-with exitus letalis (irreversible damages); 1.2-rehabilitation in persistent focal damages; 2-restoration with functional safety of brain stem. Differences of the integral cerebral reactions (the state of consciousness, emotional-affective disorders, awakening state) as well as the brain stem syndromes (formation of pathological systems, reciprocal relations between intact and destroyed brain stem structures) and diencephalic-subcortical syndromes were considered.

Behavioural manifestations of third ventricular colloid cysts.

Three patients with third ventricular colloid cysts manifested disturbances of memory, emotion and personality in the absence of hydrocephalus. All three patients demonstrated significant improvement following removal of the tumours. The symptoms and signs associated with these neoplasms may be attributed to compression or vascular compromise of the diencephalon with disorder of major limbic system structures. Tumour removal should be undertaken in patients with symptoms even in the absence of hydrocephalus, and ventricular shunting may be inadequate as a sole therapeutic measure.

Posterior fossa lesions associated with neuropsychiatric symptomatology.

We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood.