A flexible endoscope-assisted interhemispheric transcallosal approach through the contralateral ventricle for the removal of a third ventricle craniopharyngioma: A technical report

Abstract

Background:Intraventricular craniopharyngiomas are difficult to remove. We combined an interhemispheric transcallosal approach with a flexible endoscope (videoscope) for successful tumor removal.Case Description:A 52-year-old male complained of general fatigue and memory disturbance. Magnetic resonance imaging revealed a well-enhanced third ventricle mass with dilatation of lateral ventricles. During removal with the interhemispheric transcallosal approach, a videoscope that was inserted into the left lateral ventricle revealed the interface of the tumor and the ventricular wall. The tumor was pushed to the right using forceps and removed totally through the right foramen of Monro without any fornix injury.Conclusion:This procedure is a safe option for removing third ventricular tumors especially in the case with hydrocephalus.

Interhemispheric Transcallosal Transforaminal Approach and Microscopic Third Ventriculostomy for Intraventricular Craniopharyngioma Associated with Asymmetric Hydrocephalus: Case Report and Literature Review

“…They pointed out that this procedure is a safe option for removing third ventricular tumors, especially in cases with hydrocephalus. 14 We consider that microscopic or endoscopic third ventriculostomy following total tumor removal could provide avoidance of shunt placement for cases with associated hydrocephalus as presented here.…”

“…The translamina terminalis corridor using subfrontal, pterional, or basal interhemispheric approach has been used to treat suprasellar or intraventricular craniopharyngiomas. [11][12][13][14] Although this route is appropriate for accessing tumors in the inferior part of the third ventricle, it is not suitable for removal of large lesions. 14,15 Initially, we employed bifrontal interhemispheric translamina terminalis approach but due to large tumor size, anatomical limitations and fixed microsurgical angle that provided narrow and deep surgical corridor only partial tumor debulking was achieved.…”

“…[11][12][13][14] Although this route is appropriate for accessing tumors in the inferior part of the third ventricle, it is not suitable for removal of large lesions. 14,15 Initially, we employed bifrontal interhemispheric translamina terminalis approach but due to large tumor size, anatomical limitations and fixed microsurgical angle that provided narrow and deep surgical corridor only partial tumor debulking was achieved. The interhemispheric approach is an ideal procedure to access tumors located in the suprasellar region, the anterior third ventricle and the basal cisterns.…”

Intraventricular neuroepithelial tumors: Surgical outcome, technical considerations and review of literature

“…Over the last decades, further authors have proposed technically advantaged approaches to the ventricular system. Regarding the fourth ventricle, approaches as the transvermian approach (10), a subtonsillar-transcerebellomedullary approach (11), a superior transvelar approach (12) or also endoscopic techniques (13,14) were described with claiming to be the superior one. The transvermian approach has been performed frequently in history, but data showed high rates of cerebellar mutism and disequilibrium (15,16).…”

Clinical, Pathological and Surgical Risk Factors Associated with Craniopharyngioma Recurrence: A Literature Review

“…with postoperative morbidity and mortality[36]; an inadequate view of the tumor due to large tumor extensions and inappropriate surgical approach;presence of major calcifications[37] which poses a risk of damage to the hypothalamus and the optic chiasm[37] [77]; firm adherence of the tumor capsule to relatively large perforating vessels or to large basal arteries as it is safer to leave minor residual portions of tumor in anticipation of vascular damage[32] [79].…”