Tumors of the lateral and third ventricles of the brain. Possibilities of endoscopic transventricular surgery. Prospects and prognosis
Keywords:lateral ventricle, third ventricle, endoscopic approach, transcortical approach, transforaminal approach, transchroroidal approach, primary tumors, invasive tumors
Tumors of the lateral and third ventricles of the brain are uncommon in the general population. Taking into account possible disability, expected duration and quality of life of the patient in the postoperative period, radical removal of these tumors, especially invasive ones, are debatable.
Purpose: to determine the possibilities of endoscopic transventricular surgery for tumors of the lateral and third ventricles of the brain.
Materials and methods. Between 2015 and 2021, 61 patients with lateral and third ventricle tumors were treated, 9 of which were primary and 52 were invasive.
All patients had a preoperative Karnofsky Performance scale score ≥70 points. Preoperative neurological status: non-focal neurological symptoms were observed in all patients, central significant hemiparesis (up to 2 points) - in 5, cognitive-mnestic disorders - in 31, opto-chiasmatic syndrome - in 2. Obstructive hydrocephalus was diagnosed in all patients. All patients underwent full-endoscopic removal by frontal transcortical transventricular approach.
Results. Total tumor resection (within healthy tissues) was performed in 34 patients, subtotal (up to 90%) – in 17, partial – in 10 patients. The postoperative condition according to Karnofsky Performance scale in all patients was ≥70 points. Hemiplegia was registered in 8 (13.1%) patients (sustained deficiency, hemiparesis (up to 3 points) - in 2 (1.22%) patients), hemianopsia - in 4 (6.5%) patients, short-term memory impairment - in 9 ( 14.75%), regression was observed 2–4 weeks after surgery. Thirty-seven (60.7%) patients died. The remaining patients (39.3%) are under observation. Median survival was 33 weeks (95% confidence interval (CI) 28–40 weeks). Postoperative survival in patients with glioblastoma was 15 weeks, median survival was 9.5 weeks (95% CI, 4–15 weeks). Of the patients with anaplastic astrocytoma, 13 (92.9%) patients died within 38 weeks after surgery, the median survival was 18 weeks (95% CI, 14.5–29.0 weeks), 1 (7.1%) patient was under observation. Patients with anaplastic oligodendroglioma had a median survival of 34.5 weeks (95% CI - 28-40 weeks), 15 (65.2%) patients died within 40 weeks, 8 (34.8%) patients are under observation. The difference between groups in survival was statistically significant (p<0.0001). Median survival in women was 34.5 weeks (95% CI, 29–40 weeks), in men, 28 weeks (95% CI, 18–39 weeks). There were 12 (42.9%) women and 12 (36.4%) men who survived for more than 60 weeks. No statistically significant difference was found between male and female survival rates (p=0.309).
Conclusions. The ability of achieving the optimal resection volume of primary and invasive tumors of the third and lateral ventricles allows recommending the anterior endoscopic transcortical transventricular approach as an effective method of surgical treatment of these tumors. Radical endoscopic resection, as the first stage of combined treatment of patients with malignant tumors of the third and lateral ventricles, increases the patients’ life expectancy with a minimal risk of postoperative neurological complications, comparable to the life expectancy of patients with malignant tumors of supratentorial localization. To eliminate obstructive hydrocephalus and prevent the obstruction of CSF circulation in case of postoperative edema or continued growth in invasive tumors of the lateral and third ventricles, it is advisable to perform triventriculocisternostomy.
Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A. Third Ventricular Tumors: A Comprehensive Literature Review. Cureus. 2018 Oct 5;10(10):e3417. doi: 10.7759/cureus.3417
Chibbaro S, Di Rocco F, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A. Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev. 2012 Jul;35(3):331-38; discussion 338-40. doi: 10.1007/s10143-011-0370-1
Iacoangeli M, di Somma LG, Di Rienzo A, Alvaro L, Nasi D, Scerrati M. Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts. J Neurosurg. 2014 Jun;120(6):1471-6. doi: 10.3171/2014.1.JNS131102
Chibbaro S, Champeaux C, Poczos P, Cardarelli M, Di Rocco F, Iaccarino C, Servadei F, Tigan L, Chaussemy D, George B, Froelich S, Kehrli P, Romano A. Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study. Neurosurg Rev. 2014 Apr;37(2):235-41; discussion 241. doi: 10.1007/s10143-013-0508-4
Ibáñez-Botella G, Domínguez M, Ros B, De Miguel L, Márquez B, Arráez MA. Endoscopic transchoroidal and transforaminal approaches for resection of third ventricular colloid cysts. Neurosurg Rev. 2014 Apr;37(2):227-34; discussion 234. doi: 10.1007/s10143-014-0529-7
Oppido PA, Fiorindi A, Benvenuti L, Cattani F, Cipri S, Gangemi M, Godano U, Longatti P, Mascari C, Morace E, Tosatto L. Neuroendoscopic biopsy of ventricular tumors: a multicentric experience. Neurosurg Focus. 2011 Apr;30(4):E2. doi: 10.3171/2011.1.FOCUS10326
Roth J, Constantini S. Combined rigid and flexible endoscopy for tumors in the posterior third ventricle. J Neurosurg. 2015 Jun;122(6):1341-6. doi: 10.3171/2014.9.JNS141397
Tawk RG, Akinduro OO, Grewal SS, Brasiliense L, Grand W, Grotenhuis A. Endoscopic Transforaminal Transchoroidal Approach to the Third Ventricle for Cystic and Solid Tumors. World Neurosurg. 2020 Feb;134:e453-e459. doi: 10.1016/j.wneu.2019.10.099
Brusius CV, Bianchin MM, Mira JM, Frigeri T, Kruger M, Grudtner MC, Lenhardt R, Maschke S, Wolfsberger S. Single Burr-Hole Extended Transforaminal Approach for Concurrent Endoscopic Surgery in the Third Ventricle Posterior to the Foramen of Monro and Ventriculostomy: Clinical Series and Planning Steps. World Neurosurg. 2021 Jun;150:e1-e11. doi: 10.1016/j.wneu.2021.01.067
Youngbeom Se, Yong Hwy Kim, Jung Hee Kim, Doo-Sik Kong, Yun-Sik Dho, Ho Kang, Kyung-Min Kim, Jin Wook Kim, Chul-Kee Park Outcomes of the endoscopic endonasal approach for tumors in the third ventricle or invading the third ventricle J Clin Neurosci. 2021 Aug; 90:302-310. doi: 10.1016/j.jocn.2021.06.012
Changfu Zhang, Zhengcun Yan, Xiaodong Wang, Yuping Li, Hengzhu Zhang Quantitative analysis of exposure and surgical maneuverability of three purely endoscopic keyhole approaches to the floor of the third ventricle J Neurosurg Sci. 2021 Sep 21. doi: 10.23736/S0390-5616.21.05455-2
Bolin Liu, Tao Zheng, Wenhai Lv, Yuanzhi Huang, Baofu Li, Baoying Chen, Binrong Wang, Shiming He Endoscopic Endonasal Transsphenoidal Approach for Third Ventriculostomy in the Management of Obstructive Hydrocephalus J Craniofac Surg. 2021 Oct 1;32(7):e609-e612. doi: 10.1097/SCS.0000000000007613
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