Artikel
Treatment of intraventricular tumors: Surgical experience of the last 150 intraventricular lesions and development of a neurosurgical-anatomical training model for intraventricular surgery
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Autoren
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Stephan Herlan
- Klinik für Neurochirurgie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland; Institut für Klinische Anatomie und Zellanalytik, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Christine Schöne, Bernhard Hirt
- Institut für Klinische Anatomie und Zellanalytik, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Marcos Tatagiba
- Klinik für Neurochirurgie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Florian H. Ebner
- Klinik für Neurochirurgie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: To illustrate anatomy, clinical presentation and surgical treatment of ventricular lesions based on the last 150 patients operated on in our department and assess critical areas of interest. To develop a neurosurgical-anatomical model to train approaches to different areas of the ventricular system in order to evaluate different approaches according to the area of interest within the ventricles.
Method: 150 patients who underwent surgery for intraventricular lesions between 2004 and 2012 were retrospectively evaluated assessing histology, localization, clinical presentation, approach and grade of resection.
To develop a realistic training model a direct intraventricular injection was performed to conserve intraventricular anatomy in sheep brain. This model was transferred to EtOH (alcohol-glycerine) fixed human specimens and the results were evaluated with ct imaging and neuroanatomical dissections.
Results: We found 28% of solitary intraventricular lesions in the lateral ventricles, 27% in the third ventricle and 39% in the fourth ventricle, the remaining spread over more than one ventricle. Typical entities include astrocytoma (20%), ependymal tumors and tumors of choroid plexus (24%), cysts (18%), medulloblastoma (9%), meningioma (7%) and cavernoma (6%). Macroscopic complete resection could be achieved in 49%, subtotal resection in 26%. Clinical manifestations included headache (48%), vertigo (9%), nausea (8%) as well as ataxia (7%). Commonly used approaches consist of transcallosal and transcortical approaches to the lateral ventricles, transcallosal approaches to the third ventricle and median suboccipital approaches to the fourth ventricle. In the sheep model the ventricles could be gently dilated, the ventricular anatomy was nicely preserved and the tissue consistency was judged realistic. In human specimens two specimens showed good preservation of ventricular anatomy and brain parenchyma in the ct scans.
Conclusions: Intraventricular lesions pose special challenges for the anatomical knowledge and the technical knowhow of neurosurgeons. Different intraventricular regions are difficult to reach and therefore complicate total tumor resection. A special fixation and trainings model can be of great value to train and optimize neurosurgical approaches.
