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

Copyright © 2002 EDIZIONI MINERVA MEDICA

lingua: Inglese

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)


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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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