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Intraoperative Conversion from Endoscopic to Open Transcortical-Transventricular Removal of Colloid Cysts as a Salvage Procedure.

Osorio JA, Clark AJ, Safaee M, Tate MC, Aghi MK, Parsa A, McDermott MW - Cureus (2015)

Bottom Line:  To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome.  Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection.We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems.Consent was formally obtained or waived for all subjects present within this study.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurological Surgery, University of California, San Francisco.

ABSTRACT

Objective:  To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome.

Methods:  Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection. Based on common cyst location in the roof of the third ventricle, we propose a simple classification of surgical operative zones based on relationships defined by the anterior column of the fornix, the septal vein, and the medial atrial vein.

Results:  Complete capsule removal was achieved in 35% of endoscopic operations, 100% of transcortical-transventricular operations, and 63% of the interhemispheric operations. Operative time was 176 minutes for endoscopic operations, whereas the operative time for cases that converted to the transcortical-transventricular approach was 190 minutes (p=0.39).

Conclusion:  A surgical-based classification of zones within the roof of the third ventricle that can be accessed with microsurgical techniques is proposed. Both endoscopic and microsurgical cyst aspiration and excision remain options. We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems. Consent was formally obtained or waived for all subjects present within this study.

No MeSH data available.


Related in: MedlinePlus

Intraoperative images from transcortical-transventricular approach for Zone 1 cyst.(a) shows initial exposure into ventricle, showing septum pellucidum, Foramen of Monro, choroid plexus (+), and septal vein(*) on left. (b) after coagulation and cutting of choroid plexus; therefore, Foramen of Monro appearing wider, with colloid cyst (**) adjacent to septal, caudate, and thalamostriate veins. (c) incision of wall of colloid cyst (**) with an ophthalmic blade, noting that foramen is kept open with gentle countertraction on column of fornix. (d) aspiration of cyst is shown achieving full excision of cyst wall, and the foramen is open with floor of the third ventricle observed in the distance; the thalamostriate vein shown intact at the 3 o’clock position, and septal vein (*) is shown intact.
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FIG2: Intraoperative images from transcortical-transventricular approach for Zone 1 cyst.(a) shows initial exposure into ventricle, showing septum pellucidum, Foramen of Monro, choroid plexus (+), and septal vein(*) on left. (b) after coagulation and cutting of choroid plexus; therefore, Foramen of Monro appearing wider, with colloid cyst (**) adjacent to septal, caudate, and thalamostriate veins. (c) incision of wall of colloid cyst (**) with an ophthalmic blade, noting that foramen is kept open with gentle countertraction on column of fornix. (d) aspiration of cyst is shown achieving full excision of cyst wall, and the foramen is open with floor of the third ventricle observed in the distance; the thalamostriate vein shown intact at the 3 o’clock position, and septal vein (*) is shown intact.

Mentions: Zone 1 extends from the anterior column of the fornix back to the anterior margin of the septal vein (Figure 1). Small colloid cysts can be completely removed in this Zone by opening the tenia choroidea between the fornix medially and the choroid plexus laterally. Without division of the septal vein, a few additional millimeters of exposure of the roof of the third ventricle can be achieved in this way (Figures 1, 2).


Intraoperative Conversion from Endoscopic to Open Transcortical-Transventricular Removal of Colloid Cysts as a Salvage Procedure.

Osorio JA, Clark AJ, Safaee M, Tate MC, Aghi MK, Parsa A, McDermott MW - Cureus (2015)

Intraoperative images from transcortical-transventricular approach for Zone 1 cyst.(a) shows initial exposure into ventricle, showing septum pellucidum, Foramen of Monro, choroid plexus (+), and septal vein(*) on left. (b) after coagulation and cutting of choroid plexus; therefore, Foramen of Monro appearing wider, with colloid cyst (**) adjacent to septal, caudate, and thalamostriate veins. (c) incision of wall of colloid cyst (**) with an ophthalmic blade, noting that foramen is kept open with gentle countertraction on column of fornix. (d) aspiration of cyst is shown achieving full excision of cyst wall, and the foramen is open with floor of the third ventricle observed in the distance; the thalamostriate vein shown intact at the 3 o’clock position, and septal vein (*) is shown intact.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494539&req=5

FIG2: Intraoperative images from transcortical-transventricular approach for Zone 1 cyst.(a) shows initial exposure into ventricle, showing septum pellucidum, Foramen of Monro, choroid plexus (+), and septal vein(*) on left. (b) after coagulation and cutting of choroid plexus; therefore, Foramen of Monro appearing wider, with colloid cyst (**) adjacent to septal, caudate, and thalamostriate veins. (c) incision of wall of colloid cyst (**) with an ophthalmic blade, noting that foramen is kept open with gentle countertraction on column of fornix. (d) aspiration of cyst is shown achieving full excision of cyst wall, and the foramen is open with floor of the third ventricle observed in the distance; the thalamostriate vein shown intact at the 3 o’clock position, and septal vein (*) is shown intact.
Mentions: Zone 1 extends from the anterior column of the fornix back to the anterior margin of the septal vein (Figure 1). Small colloid cysts can be completely removed in this Zone by opening the tenia choroidea between the fornix medially and the choroid plexus laterally. Without division of the septal vein, a few additional millimeters of exposure of the roof of the third ventricle can be achieved in this way (Figures 1, 2).

Bottom Line:  To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome.  Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection.We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems.Consent was formally obtained or waived for all subjects present within this study.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurological Surgery, University of California, San Francisco.

ABSTRACT

Objective:  To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome.

Methods:  Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection. Based on common cyst location in the roof of the third ventricle, we propose a simple classification of surgical operative zones based on relationships defined by the anterior column of the fornix, the septal vein, and the medial atrial vein.

Results:  Complete capsule removal was achieved in 35% of endoscopic operations, 100% of transcortical-transventricular operations, and 63% of the interhemispheric operations. Operative time was 176 minutes for endoscopic operations, whereas the operative time for cases that converted to the transcortical-transventricular approach was 190 minutes (p=0.39).

Conclusion:  A surgical-based classification of zones within the roof of the third ventricle that can be accessed with microsurgical techniques is proposed. Both endoscopic and microsurgical cyst aspiration and excision remain options. We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems. Consent was formally obtained or waived for all subjects present within this study.

No MeSH data available.


Related in: MedlinePlus