scholarly journals Surgical approaches to the third ventricle of the brain in children

2021 ◽  
Vol 11 (1) ◽  
pp. 47-54
Author(s):  
Sergey K. Gorelyshev ◽  
Olga A. Medvedeva
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Anterior Horn ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Lateral Ventricles ◽  
The Brain

AIM: This study aimed to describe and analyze the advantages and disadvantages of various surgical approaches to neoplasms of the third ventricle of the brain in children. MATERIALS AND METHODS: This study analyzed surgical interventions to the third ventricle in 657 patients, performed at the Academician N.N. Burdenko of the Research Institute of Neurosurgery from 1998 to 2018. These included 375 patients with intra-extraventricular craniopharyngiomas and 282 patients with gliomas of the third ventricle and chiasm. The patients age ranged from 3 mon to 18 years old. RESULTS: The anterior transcallosal approach provides access to the anterior horn and bodies of the lateral ventricles, as well as the third ventricle. The transfornical approach provides more opportunities for access to both the anterior and posterior parts of the third ventricle; however, it has a high risk of trauma to the fornix. The subchoroidal approach provides a very good view of the posterior parts of the third ventricle, especially of the pineal region; however, it has even greater restrictions on viewing its anterior parts. When compared with the transcallosal approach, the transfrontal approach can be used more safely in the absence of hydrocephalus (if the tumor is located in the anterior horn). No specific complications were inherent in a particular approach (seizures were registered in 1%, transient hemiparesis was noted in 10%, and transient memory impairments were revealed in 5% of cases). CONCLUSION: The use of a transcallosal approach is safe even in infants. The transcortical approach is recommended mainly for large tumors of the lateral ventricles, and the transcallosal approach should be used for small tumors of the third ventricle. No specific complications were inherent in a particular approach, and the choice was determined by the assessment of the exact location of the tumor and calculation of the most relevant trajectory for its achievement as well as the aim (biopsy or radical removal). Analysis of magnetic resonance imaging and neuronavigation are significant in the selection of surgical approaches.

The Posterior Transcallosal Approach to the Pineal Region and Posterior Third Ventricle: Intervenous and Paravenous Variants

2016 ◽  
Vol 13 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Prayash G. Patel ◽  
Aaron A. Cohen-Gadol ◽  
Philippe Mercier ◽  
Frederick A. Boop ◽  
Paul Klimo
Keyword(s):  
Third Ventricle ◽  
Signs And Symptoms ◽  
Pineal Region ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Tumor Type ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
Local Progression

Abstract BACKGROUND: There are a number of surgical approaches to the posterior third ventricle and pineal region, each with its associated advantages and disadvantages. OBJECTIVE: To present our experience with the posterior interhemispheric transcallosal approach and to analyze the indications, technique, and outcomes. METHODS: A retrospective study was conducted to identify and analyze all children and young adults who underwent the posterior transcallosal approach from July 2010 to March 2015. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up. RESULTS: Twenty-two patients (9 female, 13 male) were identified in 24 cases with a mean age of 10.5 years (range, 3-32 years). The most common tumor type was pineoblastoma (n = 6). Eleven patients underwent gross total resections; 11 underwent subtotal resections; and 2 tumors were biopsied. The intervenous operative corridor was used in 15 cases; the paravenous was used in 9. Of the 22 patients, 19 experienced 31 total postoperative events. There were 12 instances of contralateral weakness. Retraction-related hemiparesis was usually temporary; resection-related hemiparesis lasted longer. There were no complications related to occlusion of one or more bridging cortical veins or from thrombosis of 1 internal cerebral vein. Eight patients have died of tumor progression, and of the remaining 14 patients, only 1 patient to date has developed local progression. CONCLUSION: The posterior interhemispheric transcallosal approach allows resection of tumors located within the pineal region, posterior third ventricle, and thalamus. New postoperative neurological deficits can occur; however, many will improve significantly or resolve completely over time.

TWO-DIMENSIONAL ULTRASONOGRAPHY: A METHOD TO STUDY NORMAL AND ABNORMAL VENTRICLES

PEDIATRICS ◽  
1968 ◽  
Vol 42 (1) ◽  
pp. 157-174
Author(s):  
Cesare T. Lombroso ◽  
Giuseppe Erba ◽  
Takeo Yogo ◽  
Nancy Logowitz
Keyword(s):  
Third Ventricle ◽  
Statistical Correlation ◽  
Ultrasonic Technique ◽  
Two Dimensional ◽  
Radiological Investigation ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Lateral Ventricles ◽  
Temporal Horn ◽  
The Brain

The authors describe an atraumatic diagnostic test apt to reveal the presence of hydrocephalus and other intracerebral anomalies in the child. It utilizes a multilevel, two-dimensional (B-mode) ultrasonic technique that is painless, safe, and easily repeatable. The use of ultrasound in neurological investigation is reviewed briefly and the advantages and disadvantages of A-mode (unidimensional) versus B-mode scanning (two-dimensional) are considered. Standards for the technique of multilevel B-mode scanning are proposed. Their validity was tested by visual and statistical correlation between ventricular measurements obtained by this technique and those obtained by classic radiological investigation. High values of the correlation coefficient were found. The results collected in scanning a group of approximately 600 infants and children are described for each of the following ventricular portions: the third ventricle, the anterior horns and the bodies of the lateral ventricles, and the trigone-temporal horn complex. Other indices of significance were those relating to the midline structures, whose shifts can be accurately predicted, and the Brain Mantle Index, which can give a rough estimate of regional or diffuse atrophic processes. While certain landmarks (such as those pertaining to the midline, third and lateral ventricles) are frequently obtained and measurable, others like those pertaining to the trigone and temporal horns are much less easily detected. Illustrative scans in normal and abnormal subjects are presented. It was concluded that this technique, although unable to outline the contour of the ventricles, lends itself to a general anatomical survey of the ventricular system both for normative purposes as well as detection of important anomalies.

COLLOID CYSTS OF THE THIRD VENTRICLE: A REVIEW OF SIXTEEN CASES

2021 ◽  
pp. 62-64
Author(s):  
Y Srinivas Rao ◽  
Hemal Chheda ◽  
Ch Surendra ◽  
M V Vijayasekhar ◽  
K Satya Varaprasad
Keyword(s):  
Benign Lesion ◽  
Third Ventricle ◽  
Clinical Manifestations ◽  
Colloid Cyst ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Complete Excision ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Colloid Cysts

BACKGROUND : Colloid cysts are one of the rare brain tumours and are mostly located in the anterosuperior portion of the third ventricle, between the fornix and surround of Foramen of Monroe. OBJECTIVES: Ÿ 1.To review the demographic information & analyse clinical manifestations of patients presenting with colloid cyst of third ventricle. Ÿ 2.To analyze the advantages and disadvantages of various surgical approaches Ÿ 3.To assess the surgical outcome in colloid cyst patients operated by any method. MATERIALS AND METHODS: A retrospective study was performed on 16 patients who presented with a colloid cyst and underwent surgery at the Department of Neurosurgery, King George Hospital, Andhra Medical College between 2013-2018. They were evaluated based on clinical ndings and imaging features, surgical approaches used for resection and their outcomes. RESULTS: Sixteen cases of colloid cyst of the third ventricle were operated upon between 2013-2018. There were seven male and nine female patients with their ages varying between 9 and 62 years old. Nine patients were operated on by using a transcortical trans-ventricular approach, four using the anterior trans-callosal approach and, three patients by using an endoscopic approach. In all patients, complete excision of the lesions was achieved. CONCLUSION: Colloid cysts, though benign, present surgical challenges because of its deep midline location. Complete excision of the colloid cyst carries an excellent prognosis. Surgery is a safe and effective treatment option for this benign lesion.

scholarly journals III. Contributions to the anatomy of the central nervous system in vertebrated animals. Part I.—Ichthyopsida. Section I.—Pisces. Subsection III.—Dipnoi. On the brain of the Ceratodus forsteri

1888 ◽  
Vol 43 (258-265) ◽  
pp. 420-423
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Pia Mater ◽  
The Third ◽  
Lateral Ventricles ◽  
Large Size ◽  
General Arrangement ◽  
Tela Choroidea ◽  
The Central Nervous System ◽  
The Brain

The brain of Ceratodus has the following general arrangement:—The membrane which represents the pia mater is of great thickness and toughness; there are two regions where a tela choroidea is developed: one where it covers in the fourth ventricle, and the other where it penetrates through the third ventricle and separates the lateral ventricles from each other. The ventricles are all of large size, and the walls of the lateral ventricles are not completed by nervous tissue. The thalamence-phalon and the mesencephalon are narrow, and the medulla oblongata is wide.

Technical strategies for the transcallosal transforaminal approach to third ventricle tumors: expanding the operative corridor

2014 ◽  
Vol 14 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Prayash Patel ◽  
Aaron A. Cohen-Gadol ◽  
Frederick Boop ◽  
Paul Klimo
Keyword(s):  
Short Term Memory ◽  
Third Ventricle ◽  
Signs And Symptoms ◽  
Surgical Approaches ◽  
Easy Method ◽  
Foramen Of Monro ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Transforaminal Approach ◽  
Common Group

Object There are a number of surgical approaches to the third ventricle, each with advantages and disadvantages. Which approach to use depends on the location of the lesion within the ventricle, the goals of the operation, and the surgeon's experience. The authors present their results in children with a modified approach through the expanded foramen of Monro. Methods A retrospective study was conducted to identify and analyze all children who underwent what the authors term the “expanded transforaminal” approach to the third ventricle between 2010 and 2013. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up. Results Twelve patients were identified (5 female, 7 male) with a mean age of 9 years (range 2–19 years). Two patients underwent gross-total resections, whereas 10 resections were less than total. There were no instances of venous infarction, significant intraoperative bleeding, or short-term memory deficits. Of the 12 patients, 7 suffered a total of 17 complications. Disruption of neuroendocrine function occurred in 4 patients: 2 with transient diabetes insipidus, 2 with permanent panhypopituitarism, and 1 with central hypothroidism (1 patient had 2 complications). The most common group of complications were CSF-related, including 2 patients requiring a new shunt. There was 1 approach-related injury to the fornix, which did not result in any clinical deficits. One child with an aggressive malignancy died of tumor progression 6 months after surgery. Of the remaining 11 patients, none have experienced tumor recurrence or progression to date. Conclusions The expanded transcallosal transforaminal approach is a safe and relatively easy method of exploiting a natural pathway to the third ventricle, but there remain blind zones in the anterosuperior and posterosuperior regions of the third ventricle.

scholarly journals Gender differences in the structure of the cerebrospinal fluid system of pre-school children

2021 ◽  
pp. 13-17
Author(s):  
S. E. Baibakov ◽  
N. S. Bakhareva ◽  
E. K. Gordeeva ◽  
M. V. Yuzhakov ◽  
D. A. Khromov ◽  
...  
Keyword(s):  
Gender Differences ◽  
Cerebrospinal Fluid ◽  
School Children ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Posterior Horn ◽  
Anterior Horn ◽  
Fluid System ◽  
The Third ◽  
The Brain

Relevance Investigation of the cerebrospinal fluid system of children of different ages, especially pre-school and school periods of childhood, becomes essential, since the further development of the brain and its proper functioning depends on the way it functions. Considering the MRI indications of the elements of the cerebrospinal fluid system of children is important for the development of neurology and neurosurgery, it is necessary to consider gender differences in the brain size and structure.Objective To study the sex differences in the structure of the cerebrospinal fluid system in seven-year-old children.Material and Methods For the study, archival data on the sizes of the lateral ventricles of the brain of 120 children aged 7 (60 boys and 60 girls) were involved, in particular: 1) the length of the anterior horn; 2) the width of the anterior horn; 3) the length of the central part; 4) the width of the central part; 5) the length of the posterior horn; 6) the width of the posterior horn; 7) the length of the lower horn; 8) the anteroposterior size; 9) the distance between the anterior horns; 10) the distance between the posterior horns; 11) the length of the third ventricle; 12) the height of the third ventricle; 13) the length of the aqueduct; 14) the length of the fourth ventricle; 15) the height of the fourth ventricle. The studies were carried out using the method of magnetic resonance imaging. Quantitative indicators were assessed for compliance with the normal distribution using the KolmogorovSmirnov test. The accumulation, correction, systematization of the initial information were carried out in Microsoft Excel 2016. Statistical analysis was carried out using the Statistica 10.0 software (StatSoft Inc., USA). The results were considered statistically significant at p < 0.05.Results The data obtained in the study of the cerebrospinal fluid system in children during their pre-school period of childhood are indicators of the norm and can be used for diagnostic studies in the departments of radiation diagnostics. The bilateral asymmetry of the lateral ventricles of the brain in pre-school children, discovered during the work, is of crucial clinical significance. The morphometric indicators of the elements of the cerebrospinal fluid system should be considered by specialists in the study of brain neuroplasticity.Conclusion Analysis of the obtained in vivo encephalometric data indicates the presence of sexual variability of the brain and parameters of the structures of the cerebrospinal fluid.

scholarly journals Transcortical–transforaminal microscopic approach for purely intraventricular craniopharyngioma

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Roukoz Chamoun ◽  
William T. Couldwell
Keyword(s):  
Third Ventricle ◽  
Senior Author ◽  
Pituitary Stalk ◽  
Surgical Approaches ◽  
Foramen Of Monro ◽  
Transcallosal Approach ◽  
The Third ◽  
Rare Location ◽  
Hypothalamic Pituitary Axis

Purely intraventricular craniopharyngiomas are rare and pose particular surgical challenges. The two main surgical approaches to these lesions based in the anterior third ventricle are the frontal transventricular approach (through a transcortical or transcallosal approach) and the trans–lamina terminalis approach. The authors note that the pituitary stalk in many of these cases is located in a normal position, which suggests that the third ventricular floor is intact. In such cases, the senior author chooses an approach to avoid disruption of the floor of the third ventricle. Specifically, a traditional frontotemporal approach is not used; we have found that in such cases, a frontal transventricular approach through the usually dilated foramen of Monro provides an optimal visualization of the tumor while minimizing the risks of injury to the hypothalamus and pituitary stalk. The endoscope can be very helpful in exploring blind angles, hidden from the microscopic view. Recognition of this rare location variant of craniopharyngioma is helpful in preoperative planning in an effort to reduce hypothalamic pituitary axis damage. Two patients presenting with craniopharyngiomas that were entirely intraventricular are shown in the video. The patients underwent removal of their tumors without incurring new long-term endocrine deficits.The video can be found here: http://youtu.be/VFlhm_lsrGY.

scholarly journals Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

2020 ◽  
Vol 39 (02) ◽  
pp. 149-153 ◽  
Author(s):  
Marcelo Paglioli Ferreira ◽  
Eduardo Cambruzzi ◽  
Otávio Garcia Martins ◽  
Guilherme Gago ◽  
Antônio Delacy Martini Vial
Keyword(s):  
Third Ventricle ◽  
Inflammatory Cells ◽  
Medical Attention ◽  
Transcallosal Approach ◽  
Visual Deficits ◽  
The Third ◽  
First Case ◽  
Cystic Component ◽  
The Brain

Abstract Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10–20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 × 2.3 cm with a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique

scholarly journals Endoscopic resection of the third ventricular epidermoid cysts: A case review and review of literature

2019 ◽  
Vol 10 ◽  
pp. 98
Author(s):  
Samir Kashyap ◽  
Bhagat Cheema ◽  
Vaninder Chhabra
Keyword(s):  
Tumor Recurrence ◽  
Third Ventricle ◽  
Gross Total Resection ◽  
Case Review ◽  
Total Resection ◽  
Transcallosal Approach ◽  
Epidermoid Cysts ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Microsurgical Techniques

Background: Epidermoid cysts are benign, congenital lesions that originate from ectodermal cells, they are most commonly found in the cerebellopontine angle, but rarely in the ventricular system. There is limited literature regarding the different microsurgical techniques utilized to approach these lesions. Methods: A 63-year-old female with a recurrent third ventricular epidermoid cyst underwent gross total resection utilizing an endoscopic technique. We also reviewed the various endoscopic/microsurgical approaches and outcomes reported in literature. Results: We identified 15 cases, including our own. Nine of these were managed using microsurgical techniques, while six cases (including ours) were treated endoscopically; gross total resection was achieved in 10/15 cases (67%). Most commonly, surgeons utilized the interhemispheric transcallosal approach (five cases). Tumor recurrence was seen in two cases. Complications attributed to these resections included: disorders of the hypothalamic-pituitary axis (3) – diabetes insipidus, galactorrhea, and hypopituitarism; tumor recurrence (2); aseptic meningitis (1); and a transient Korsakoff syndrome (1). Conclusion: Epidermoid cysts of the third ventricle are exceedingly rare, and surgical resection is generally well tolerated. Microsurgical transcortical, transcallosal, and endoscopic approaches each have advantages and disadvantages, and are associated with unique procedure-specific complications. Continuing technological improvement would favor endoscopic approaches for resection of tumors of the third ventricle in the future.

scholarly journals A 3D endoscopic transtubular transcallosal approach to the third ventricle

2015 ◽  
Vol 122 (3) ◽  
pp. 564-573 ◽  
Author(s):  
Alireza Shoakazemi ◽  
Alexander I. Evins ◽  
Justin C. Burrell ◽  
Philip E. Stieg ◽  
Antonio Bernardo
Keyword(s):  
Corpus Callosum ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Surgical Approaches ◽  
Tubular Retractor ◽  
Transcallosal Approach ◽  
The Third ◽  
Vascular Structures ◽  
Clear Plastic ◽  
Surgical Corridor

OBJECT Surgical approaches to deep-seated brain pathologies, specifically lesions of the third ventricle, have always been a challenge for neurosurgeons. In certain cases, the transcallosal approach remains the most suitable option for targeting lesions of the third ventricle, although retraction of the fornices and wall of the third ventricle have been associated with neuropsychological and hypothalamic deficits. The authors investigated the feasibility of an interhemispheric 3D endoscopic transcallosal approach through a minimally invasive tubular retractor system for the management of third ventricular lesions. METHODS Three-dimensional endoscopic transtubular transcallosal approaches were performed on 5 preserved cadaveric heads (10 sides). A parasagittal bur hole was placed using neuronavigation, and a tubular retractor was inserted under direct endoscopic visualization. Following observation of the vascular structures, fenestration of the corpus callosum was performed and the retractor was advanced through the opening. Transforaminal, interforniceal, and transchoroidal modifications were all performed and evaluated by 3 surgeons. RESULTS This approach provided enhanced visualization of the third ventricle and more stable retraction of corpus callosum and fornices. Bayonetted instruments were used through the retractor without difficulty, and the retractor applied rigid, constant, and equally distributed pressure on the corpus callosum. CONCLUSIONS A transtubular approach to the third ventricle is feasible and facilitates blunt dissection of the corpus callosum that may minimize retraction injury. This technique also provides an added degree of safety by limiting the free range of instrumental movement. The combination of 3D endoscopic visualization with a clear plastic retractor facilitates safe and direct monitoring of the surgical corridor.

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