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Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases.

Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G - Asian J Neurosurg (2014)

Bottom Line: With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease.With increasing experience, most of the complications are avoidable.The limited anterior callosotomy does not result in disconnection syndromes.

View Article: PubMed Central - PubMed

Affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India.

ABSTRACT

Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle.

Materials and methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery.

Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome.

Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.

No MeSH data available.


Related in: MedlinePlus

Preoperative MRI of the Brain sagittal, (a) and axial, (b) showing colloid cyst in the anterior third ventricular region. Postoperative CT scan of the brain, (c-e) showing venous infarct in the right frontal lobe causing mass effect. Ventricular catheter of the external ventricular drainage is seen to be in the ventricle
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Figure 1: Preoperative MRI of the Brain sagittal, (a) and axial, (b) showing colloid cyst in the anterior third ventricular region. Postoperative CT scan of the brain, (c-e) showing venous infarct in the right frontal lobe causing mass effect. Ventricular catheter of the external ventricular drainage is seen to be in the ventricle

Mentions: Postoperative seizures were seen in six patients, due to one of these complications: Right frontal lobe venous infarct, frontal horn pneumocephalus, acute hydrocephalus, and brain retraction edema [Table 2]. This can be avoided by minimal retraction of the frontal lobe and sacrifice of bridging veins. If a vein needs to be sacrificed, then retractor should not be applied on the area of drainage. Seizures can also be prevented by the use of preoperative anticonvulsants. Acute hydrocephalus occurred in four patients and all underwent a CSF diversion procedure. This may occur due to block in the CSF pathways due to incomplete excision of the lesion or a blood clot blocking the aqueduct. If such situations are anticipated, an external ventricular drain (EVD) can be kept within the lateral ventricle. Postoperatively, the EVD can be kept closed and if there is deterioration in sensorium, it can be opened. Venous cortical infarct was seen in four patients [Figure 1]. This can be prevented by avoiding sacrifice of the bridging veins and prolonged excessive retraction of the frontal lobe. Transient hemiparesis occurred in four patients, due to retraction edema [Figure 2], venous infarct, and prolonged pericallosal artery retraction. Transient memory impairment occurred in nine patients within the first 72 hours after surgery, which completely resolved by the 7th postoperative day in seven patients. Mutism occurred in one patient. These can occur due to excess handling of the fornix, especially on the left side, and walls of the third ventricle and will recover in time. The opening in the callosum must be less than 2.5 centimeters to avoid disconnection syndromes. One patient had subdural hematoma which required evacuation. This was seen in a patient with gross hydrocephalus and can be avoided by initially making a small opening in the corpus callosum and letting out CSF slowly. The brain may bulge during surgery and, if no other cause is obvious, acute SDH must be considered. Meningitis occurred in three patients. Tension pneumocephalus occurred in one patient [Figure 3], and the postoperative recovery was delayed. A plain X-ray of the skull lateral view will clinch the diagnosis and a frontal burr hole with tapping of the air will help relieve the pneumocephalus. Two patients died in the postoperative period due to basal ganglia hemorrhagic infarct following vascular injury [Table 2]. Majority of the above complications occurred during the initial years.


Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases.

Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G - Asian J Neurosurg (2014)

Preoperative MRI of the Brain sagittal, (a) and axial, (b) showing colloid cyst in the anterior third ventricular region. Postoperative CT scan of the brain, (c-e) showing venous infarct in the right frontal lobe causing mass effect. Ventricular catheter of the external ventricular drainage is seen to be in the ventricle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129577&req=5

Figure 1: Preoperative MRI of the Brain sagittal, (a) and axial, (b) showing colloid cyst in the anterior third ventricular region. Postoperative CT scan of the brain, (c-e) showing venous infarct in the right frontal lobe causing mass effect. Ventricular catheter of the external ventricular drainage is seen to be in the ventricle
Mentions: Postoperative seizures were seen in six patients, due to one of these complications: Right frontal lobe venous infarct, frontal horn pneumocephalus, acute hydrocephalus, and brain retraction edema [Table 2]. This can be avoided by minimal retraction of the frontal lobe and sacrifice of bridging veins. If a vein needs to be sacrificed, then retractor should not be applied on the area of drainage. Seizures can also be prevented by the use of preoperative anticonvulsants. Acute hydrocephalus occurred in four patients and all underwent a CSF diversion procedure. This may occur due to block in the CSF pathways due to incomplete excision of the lesion or a blood clot blocking the aqueduct. If such situations are anticipated, an external ventricular drain (EVD) can be kept within the lateral ventricle. Postoperatively, the EVD can be kept closed and if there is deterioration in sensorium, it can be opened. Venous cortical infarct was seen in four patients [Figure 1]. This can be prevented by avoiding sacrifice of the bridging veins and prolonged excessive retraction of the frontal lobe. Transient hemiparesis occurred in four patients, due to retraction edema [Figure 2], venous infarct, and prolonged pericallosal artery retraction. Transient memory impairment occurred in nine patients within the first 72 hours after surgery, which completely resolved by the 7th postoperative day in seven patients. Mutism occurred in one patient. These can occur due to excess handling of the fornix, especially on the left side, and walls of the third ventricle and will recover in time. The opening in the callosum must be less than 2.5 centimeters to avoid disconnection syndromes. One patient had subdural hematoma which required evacuation. This was seen in a patient with gross hydrocephalus and can be avoided by initially making a small opening in the corpus callosum and letting out CSF slowly. The brain may bulge during surgery and, if no other cause is obvious, acute SDH must be considered. Meningitis occurred in three patients. Tension pneumocephalus occurred in one patient [Figure 3], and the postoperative recovery was delayed. A plain X-ray of the skull lateral view will clinch the diagnosis and a frontal burr hole with tapping of the air will help relieve the pneumocephalus. Two patients died in the postoperative period due to basal ganglia hemorrhagic infarct following vascular injury [Table 2]. Majority of the above complications occurred during the initial years.

Bottom Line: With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease.With increasing experience, most of the complications are avoidable.The limited anterior callosotomy does not result in disconnection syndromes.

View Article: PubMed Central - PubMed

Affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India.

ABSTRACT

Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle.

Materials and methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery.

Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome.

Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.

No MeSH data available.


Related in: MedlinePlus