Different Approaches and Outcome of Surgery for Tumors of the Lateral and Third Ventricle: an Institutional Series of 42 Patients

Objective: To review surgical approaches and outcome of patients with intraventricular lateral and third ventricle tumors operated at our institution.

Methods: Review of all patients who had surgery for excision of lateral and third ventricle tumors at KKUH during the period from 2004 to 2015. Demographic, clinical, radiological, Surgical, histopathology, and follow up data were reviewed and analyzed.

Results: A total of 42 patients; 20 males and 22 females. The mean patient age was 25 years (range, 2 months to 65 years). The main presenting symptoms were headache 69%, nausea/vomiting 38%, visual disturbances 24%, disturbed consciousness 9.5%, seizures 16.6% and motor weakness 7.1%. The tumors were located in the third ventricle in twenty-three (54.8%), in the lateral ventricles in eighteen patients (42.8%), and in both lateral and third ventricle in one patient (2.4%). The transcortical approach was used in 30 patients (70.5%), the trans-callosal approach was used in 5 patients (12%), and other approaches were used for 18 patients. Postoperative complications included seizures in 5 patients (12%) of the patients, intraventricular hemorrhage in 3 patients (7%), ventriculitis and brain abscess in one patient (2.3%) and motor weakness in one patient. Two surgical mortalities (4.7%), one from hypothalamic syndrome and the other one from CNS infection. Histopathology showed astrocytoma in 8 patients (18.8) & one GBM, colloid cyst in 6 patients (14.2%), pineal region tumors 7 patients (, and central neurocytoma in 5 patients (11.9%), pineal tumors in 6 patients (14.2%), ependymoma in 3 patients (7.1%), ATRT in 3 patients (7.1%), meningioma in 2 patients (4.7), and one case of lymphoma, choroid plexus papilloma, craniopharyngioma, and Langerhans cell histiocytosis

Conclusion: Intraventricular tumors are mostly benign, and the best treatment modality is surgical resection. Selection of surgical approach should be made individually according to the location, type and size of the lesion, vascularity, venous drainage, and relationship to surrounding structures.

Keywords

intraventricular tumors - third ventricle - astrocytoma - colloid cyst - central neurocytoma - pineal tumors - surgical approaches - complications - outcome