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Journal of Neurosurgical Sciences 2002 June;46(2):60-5

language: English

Surgical approach­es to ­tumours of the lat­er­al ven­tri­cles in the dom­i­nant hem­i­sphere

Santoro A. 1, Salvati M. 2, Frati A. 2, Polli F. M. 1, Delfini R. 1, Cantore G. 1

1 Neurosurgery, Department of Neurological Sciences, “La Sapienza” University, Rome;
2 Department of Neurosurgery, I­RCCS INM Neuromed, Pozzilli (IS)


Background. Intraventricular neo­plasms are ­rare ­tumours (1% of the ­tumours of the cen­tral ner­vous ­system). The sur­gi­cal ­approach some­times is ­quite dif­fi­cult, par­tic­u­lar­ly in the dom­i­nant hem­i­sphere. The ­best ­choice of sur­gi­cal ­approach is dis­cussed.
Methods. The ­authors ­describe a ­series of 25 ­patients who under­went sur­gi­cal treat­ment for ­tumours sit­u­at­ed in the lat­er­al ven­tri­cles of the dom­i­nant hem­i­sphere. They dis­cuss the ­most influen­tial fac­tors in the ­choice of sur­gi­cal ­approach, ­which ­must ­allow max­i­mum expo­sure of the ­lesion and vas­cu­lar feed­ing branch­es with­out dam­ag­ing high­ly func­tion­al are­as (­motor, vis­u­al and lan­guage are­as). In par­tic­u­lar, ­they ­report ­their expe­ri­ence ­using a low trans­tem­po­ral ­route, ­between the mid­dle and infe­ri­or ­gyri, for remov­ing ­tumours local­ized in the tem­po­ral ­horn and/or ­trigone ­which ­made it pos­sible to ­keep post­op­er­a­tive vis­u­al and phas­ic def­i­cits to a min­i­mum.
Results. In 5 ­patients the ­approach was ­transfron­tal, in 10 tem­po­ral, in 6 super­i­or parie­to-occip­i­tal and in 4 ­transcal­lo­sal. Three ­patients ­died. Only 5 ­patients pre­sent­ed per­ma­nent def­i­cits (ano­mia, aprax­ia and vis­u­al ­fields alter­a­tions).
Conclusions. The ­size, ­site, hem­i­sphere and vas­cu­lar­iza­tion of intra­ven­tric­u­lar ­tumours influ­ence the ­choice of sur­gi­cal ­approach. The ­basal ­transtem­po­ral ­approach is par­tic­u­lar­ly indi­cat­ed to ­remove ­tumours of the tem­po­ral ­horn and ­trigone and it ­seems to ­reduce the ­risk of ­speech dis­tur­banc­es and alter­a­tions of pos­ture.

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