Neurosurgeon Romodanov Neurosurgery Institute Kiev, Ukraine
Introduction: Thalamic tumors surgery is complicated and deep cerebral veins are at risk. Endosopic frontal transcortical transventricular approach is of primary choice, but has some disadvantages in reaching the posterior part of the 3rd ventricle. Anterior choroidal dissection would enlarge the foramen Monro (not always extended by concomitant hydrocephalus, in our case it was not enlarged in 32% cases).
Methods: We have reviewed 42 patients with the invasive thalamic tumors to the 3rd ventricle. Histological distribution: 23 patients (pat.) with anaplastic oligodendroglioma (WHO grade 3), 14 pat. - anaplastic astrocytoma (WHO grade 3), 5 pat. – glioblastoma (WHO grade 4). In all cases we used the extended transforaminal approach (f. Monro being extended with anterior choroidal dissection).
Results: Gross total resection was achieved in 18 cases, subtotal resection - 15 cases, partial resection – 9 cases. Karnofsky Scale in the postoperative period demonstrated 70 points in all patients. Neurological complications have been observed in 11 (26,19%) patients. Hemiplegia in 7 (16,6%) patients (in 3 of them – persistent). Hemianopsia - in 5 patients (11.9%), persistent; transient mutism (took place when the approach was used on the patient`s dominants hemisphere) - in 6 patients (14.28%) – regression in 1-3 weeks, working memory disturbance - in 7 patients (16,6%) – regression in 2-4 weeks. Median survival in our patients amounted to 17.1 months (range from 12.1 months to 28.4 months). There was no postoperative mortality.
Conclusion : 1. Endoscopic frontal transcortical transventricular approach, in some cases extended with anterior transchoroidal dissection, is an effective method of thalamic tumors surgical treatment. 2. The postoperative neurological complications are mostly transient in nature, thus neurological complication are acceptable in view of the median survival in patients with thalamic tumors. 3. Endoscopic frontal transcortical transventricular surgery to thalamic tumors is as effective as the surgery to similar supratentorial gliomas.
