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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 2 cyst.(a) shows initial exposure into ventricle, showing Foramen of Monro, choroid plexus (+), and septal vein (*) on left. (b) after coagulation and cutting of choroid plexus and extension past septal vein; therefore, Foramen of Monro appears wider, with colloid cyst (**) adjacent to thalamostriate vein. (c) Zone 2 dissection is extended to anterior margin of the medial atrial vein (++) that is left intact, colloid cyst (**) is noted encompassing all of Zone 2. (d) colloid cyst (**) is carefully isolated from its adjacent blood supply. (e) medial atrial vein (++) is preserved, and (f) wide exposure obtained after careful resection.
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FIG3: Intraoperative images from transcortical-transventricular approach for Zone 2 cyst.(a) shows initial exposure into ventricle, showing Foramen of Monro, choroid plexus (+), and septal vein (*) on left. (b) after coagulation and cutting of choroid plexus and extension past septal vein; therefore, Foramen of Monro appears wider, with colloid cyst (**) adjacent to thalamostriate vein. (c) Zone 2 dissection is extended to anterior margin of the medial atrial vein (++) that is left intact, colloid cyst (**) is noted encompassing all of Zone 2. (d) colloid cyst (**) is carefully isolated from its adjacent blood supply. (e) medial atrial vein (++) is preserved, and (f) wide exposure obtained after careful resection.

Mentions: Zone 2 extends from the anterior margin of the septal vein to the anterior margin of the medial atrial vein. Access to this zone requires isolation, coagulation, and division of the septal vein, preserving the patency of the thalamostriate and internal septal veins. Once the vein is coagulated, the tenia fornicea can be opened along the roof of the third ventricle, lateral to the body of the fornix and medial to the choroid plexus and internal cerebral veins. Large cysts in this zone can be carefully isolated from their blood supply from the posterior medial choroidal arteries, and the cyst wall can be excised completely (Figures 1, 3).


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 2 cyst.(a) shows initial exposure into ventricle, showing Foramen of Monro, choroid plexus (+), and septal vein (*) on left. (b) after coagulation and cutting of choroid plexus and extension past septal vein; therefore, Foramen of Monro appears wider, with colloid cyst (**) adjacent to thalamostriate vein. (c) Zone 2 dissection is extended to anterior margin of the medial atrial vein (++) that is left intact, colloid cyst (**) is noted encompassing all of Zone 2. (d) colloid cyst (**) is carefully isolated from its adjacent blood supply. (e) medial atrial vein (++) is preserved, and (f) wide exposure obtained after careful resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG3: Intraoperative images from transcortical-transventricular approach for Zone 2 cyst.(a) shows initial exposure into ventricle, showing Foramen of Monro, choroid plexus (+), and septal vein (*) on left. (b) after coagulation and cutting of choroid plexus and extension past septal vein; therefore, Foramen of Monro appears wider, with colloid cyst (**) adjacent to thalamostriate vein. (c) Zone 2 dissection is extended to anterior margin of the medial atrial vein (++) that is left intact, colloid cyst (**) is noted encompassing all of Zone 2. (d) colloid cyst (**) is carefully isolated from its adjacent blood supply. (e) medial atrial vein (++) is preserved, and (f) wide exposure obtained after careful resection.
Mentions: Zone 2 extends from the anterior margin of the septal vein to the anterior margin of the medial atrial vein. Access to this zone requires isolation, coagulation, and division of the septal vein, preserving the patency of the thalamostriate and internal septal veins. Once the vein is coagulated, the tenia fornicea can be opened along the roof of the third ventricle, lateral to the body of the fornix and medial to the choroid plexus and internal cerebral veins. Large cysts in this zone can be carefully isolated from their blood supply from the posterior medial choroidal arteries, and the cyst wall can be excised completely (Figures 1, 3).

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