Translamina terminalis approach to the hypothalamus using supraorbital craniotomy: Technical note and comparison with other surgical corridors

Abstract

Objectives: Approaches to the hypothalamus and anterior third ventricle are variable. We present a technical note on access of the hypothalamus using the trans-lamina terminalis approach by supraorbital craniotomy in a patient who had a hypothalamic cavernoma and presented to us with recurrent hemorrhage. Patients and methods: The trans-lamina terminalis approach, including anatomical landmarks and surgical steps through a supra-orbital craniotomy, is described and a comparison with other surgical corridors is discussed. Results: The supraorbital trans lamina terminalis approach allowed an effective access to the hypothalamic lesions. This approach provided a safe and minimally invasive corridor for gross total resection of the lesion since trespass of viable brain tissue is avoided. One clinical case illustrates the feasibility of the approach allowing complete removal of a cavernoma without surgery related neurological of endocrinological deficits. Conclusions: The supra-orbital craniotomy for trans-lamina terminalis approach is a valid surgical choice for hypothalamic lesions. The major strengths of this approach include minimal brain retraction and direct end-on view; however, the long and narrow surgical corridor requires some technical familiarization. The clinical outcomes are comparable to other surgical corridors.

The minimally invasive transventricular endoscopic approach to third ventricular lesions in pediatric patients—all-rounder with limitations?

“…Common choices for accessing the third ventricle include the transcallosal interforniceal approach [ 1 – 4 ], the subfrontal translamina terminalis approach [ 2 , 5 – 7 ], the transventricular transforaminal approach [ 2 , 8 – 11 ], the transventricular transchoroidal approach, the supracerebellar-infratentorial approach [ 12 – 15 ], and the interhemispheric transtentorial occipital approach. Each of these approaches has been presented with several variations.…”