Artikel
Transcortical versus transcallosal approaches to lesions in and adjacent to the lateral and third ventricles – advantages and risks
Vergleich des transcorticalen mit dem transcallosalen operativen Zugangsweg zur Resektion von Läsionen in der Nähe von den Seitenventrikeln und des 3. Ventrikels – Vorteile und Risiken
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Veröffentlicht: | 8. Mai 2019 |
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Objective: Intraventricular tumors can be adressed by two main surgical approaches. Depending on the extent and localization of the lesion, there are important differences between the operative routes and techniques for resection regarding interoperative damage to functional brain tissue and postoperative morbidity. The study aims to analyse long-term results of either interhemispheric/transcallosal or transcortical resection of these lesions.
Methods: Between 2007 and 2018, 31 adult patients were operated on intraventricular lesions in two maxmimum care hospitals. Group A (transcortical approach) consisted of 15 patients (7 female, 8 male; age (mean, 1 SD) 47.3±19.7 yrs), whereas group B (transcallosal approach) included 16 patients (8 female, 8 male; age 48.3±17.5 yrs). The groups were compared for completeness of resection according to latest MRI scans, operating time, complications, postoperative neurological and cognitive deficits as well as the incidence of postsurgical seizures. All patients were operated on using neuronavigation, 13 patients (8 group A, 5 group B) underwent surgery using intraoperative 1.5T-MRI (iopMRI). Clinical follow-up was 85.3±44.1 and 64.8±42.2 months in group A and B, respectively.
Results: Gross-total resection was archieved in 11/15 (73%) in group A and 11/16 (69%) in group B. Of the 13 patients who were operated on using iopMRI, 4 (31%) had incomplete resections (2 group A and B each). The operating time in B was longer (288.9±139.5 minutes) compared to 186.6±98.3 minutes in A. Complications (intracranial hemorrhage, meningitis, cerebral infarction, wound infection) occurred in 6/15 (40%) of the patients in group A, whereas the transcallosal group had a rate of 3/16 (19%). Postoperative neurological deficits (hemiparesis, aphasia, ataxia) occurred in 2/15 (13%) and 4/16 (25%) in group A and B, respectively. The transcallosal group had a higher rate of new diagnosed memory impairment (25%) as compared to the transcortical group (13%). Seizures occurred in 3/15 (20%) patients of group A and 3/16 (19%) patients in group B.
Conclusion: The transcallosal approach seems to be prone to cognitive deficits and longer operation time with less complete resections, whereas the transcortical route seems to be associated with less surgical complications and postoperative neurological deficits. Intraoperative MRI contributed to the rate of complete resections in both groups.