Surgical approach to the third ventricle masses and results

Introduction: The selection of surgical approach to the third ventricle masses includes difficulties due to their deep localizations, close proximity to the vascular and the eloquent brain structures. The most appropriate approach that should be chosen in surgical treatment of third ventricle masses is still controversial. In this study, the factors in the choice of surgical approach to the third ventricle masses and the results of them were investigated. Method: In this study, 80 patients who underwent surgery in our clinic due to the third ventricle masses were retrospectively analyzed between the years 2002-2014. All of the cases were evaluated in terms of clinical and neuroradiological results pre and postoperatively. In 47 cases the anterior interhemispheric trans-callosal, in 10 cases the posterior interhemsipheric transcallosal, in 15 cases pterional trans-sylvian translaminar, in 5 cases the supracerebellar-infratentorial and in 3 cases the combined surgical approaches (Pterional-Transsylvian + Anterior interhemsipheric transcallosal transforaminal) were performed. Results: Gender distribution of the cases were 42 M / 38 F and the mean age of them was 24,5 years (3 mo - 63 yrs). In 60 patients the total resection was performed, whereas in 20 patients subtotal resection was performed due to the infiltration of eloquent brain areas. In the histopathological examination; 32 colloid cyst masses, 28 neuroepithelial, 12 sellar region tumors, 4 meningeal, 2 germ cell, 1 lympho-hematopoetic system and 1 chordoma were observed. After surgery, additional neurological deficits developed in 14 patients. The mortality was observed in 9 patients postoperatively. The average follow-up time was 51 (1-144) months. Conclusion: The essential factors which affect the results of surgical treatment of third ventricul masses are; the size of the mass, histopathology, location, extention and the relationship to the neurovascular structures. The goal of surgery is to provide the histopathological diagnosis, gross total resection, if it is possible, and to normalize the flow of cerebrospinal fluid by eliminating the mass effect of the tumor.