Intraventricular craniopharyngioma [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Intraventricular craniopharyngioma ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1-khLOXmKonPtxkzNm4sk_2_U7O4c5e_dC9-dHL-e3IE4dmY2x/?limit=15&utm_campaign=pubmed-2&fc=20240326191740}}
----

----

Intraventricular [[craniopharyngioma]]s account for 0.5–11% of all craniopharyngiomas
((Behari S, Banerji D, Mishra A, Sharma S, Chhabra DK, Jain VK. Intrinsic third ventricular craniopharyngiomas: Report on six cases and a review of the literature. Surg Neurol. 2003;60:245–52.))
((Sipos L, Vajda J. Craniopharyngioma of the third ventricle. Acta Neurochir. 1997;139:92–3.))

These tumors show an intact [[third ventricle]] floor, a [[suprasellar cistern]], a normal [[pituitary stalk]], and an absence of sellar abnormalities
((Jung TY, Jung S, Jang WY, Moon KS, Kim IY, Kang SS. Operative outcomes and adjuvant treatment of purely third ventricle craniopharyngioma after a transcallosal approach. Br J Neurosurg. 2012;26:355–60.)).

Intraventricular craniopharyngiomas are difficult to remove. 

====Approaches====
The two main surgical approaches for these lesions are the [[translamina terminalis approach]] and the transventricular approaches. The translamina terminalis approach using subfrontal, pterional, or basal [[interhemispheric approach]]es has been used to treat suprasellar or intraventricular craniopharyngiomas
((Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: Experience with 168 patients. J Neurosurg. 1999;90:237–50.))
((Hori T, Kawamata T, Amano K, Aihara Y, Ono M, Miki N. Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle. Neurosurgery. 2010;66(3 Suppl Operative):S65–74.))
((Ohata K, Hakuba A, Nagai K, Morino M, Iwa Y. A biorbitofrontobasal interhemispheric approach for suprasellar lesions. Mt Sinai J Med. 1997;64:217–21.)).

Although this approach is easy for accessing tumors in the inferior part of the third ventricle, it is difficult to remove large lesions
((Shiramizu H, Hori T, Matsuo S, Niimura K, Yoshimoto H, Ishida A, et al. Anterior callosal section is useful for the removal of large tumors invading the dorsal part of the anterior third ventricle: Operative technique and results. Neurosurg Rev. 2013;36:467–75.)).

The [[transventricular approach]] through a transcortical or [[transcallosal approach]] allows access to the [[third ventricle]] with transforaminal, subchoroidal, or transfornician approaches. The usefulness of these approaches have been reported for intraventricular tumor removal
((Chamoun R, Couldwell WT. Transcortical-transforaminal microscopic approach for purely intraventricular craniopharyngioma. Neurosurg Focus. 2013;34(1 Suppl) Video 4.))
((Danaila L, Radoi M. Surgery of tumors of the third ventricle region. Chirurgia (Bucar) 2013;108:456–62.))
((Liu JK. Interhemispheric transcallosal approach for resection of intraventricular central neurocytoma. Neurosurg Focus. 2013;34(1 Suppl) Video 3))
((Tomasello F, Cardali S, Angileri FF, Conti A. Transcallosal approach to third ventricle tumors: How I do it. Acta Neurochir. 2013;155:1031–4))
but there is a risk of injuries to the surrounding neuronal or vascular structures, such as the body of the [[fornix]]. 


====Case reports====
We combined an interhemispheric transcallosal approach with a flexible endoscope (videoscope) for successful tumor removal.


A 52-year-old male complained of general fatigue and memory disturbance. Magnetic resonance imaging revealed a well-enhanced third ventricle mass with dilatation of lateral ventricles. During removal with the interhemispheric transcallosal approach, a videoscope that was inserted into the left lateral ventricle revealed the interface of the tumor and the ventricular wall. The tumor was pushed to the right using forceps and removed totally through the right foramen of Monro without any fornix injury.


This procedure is a safe option for removing third ventricular tumors especially in the case with hydrocephalus
((Yano S, Hide T, Shinojima N, Ueda Y, Kuratsu J. A flexible endoscope-assisted 
interhemispheric transcallosal approach through the contralateral ventricle for
the removal of a third ventricle craniopharyngioma: A technical report. Surg
Neurol Int. 2015 Mar 19;6(Suppl 2):S113-6. doi: 10.4103/2152-7806.153653.
eCollection 2015. PubMed PMID: 25883855; PubMed Central PMCID: PMC4392546.
)).