Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy; Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy.
World Neurosurg. 2020 Oct;142:197-205. doi: 10.1016/j.wneu.2020.06.222. Epub 2020 Jul 5.
Colloid cysts of the third ventricle are rare benign lesions, which amount to approximately 1% of all intracranial tumors. Because these lesions grow predominantly in the anterior aspect of the third ventricle, they may cause the occlusion of the foramina of Monro, generating obstructive hydrocephalus. Surgery is mandatory in cases of large cysts and/or in symptomatic patients. Among the different surgical strategies described in colloid cysts surgery, the microsurgical transcallosal approach still constitutes the procedure of choice in many centers. In this study, we describe a modified microsurgical transcallosal approach, the interhemispheric transgenual approach, in a series of 13 consecutive patients operated on for colloid cysts of the third ventricle.
All the procedures were performed by the senior author (V.E.) at Neuromed Institute of Pozzilli (Is, Italy). The operative procedure is described in its various steps, illustrating the differences and potential advantages compared with the traditional microsurgical transcallosal approach.
No surgical complications or new-onset neurologic deficits were observed in the postoperative period. The postoperative magnetic resonance imaging confirmed in all cases complete lesion removal without any sign of parenchymal damage. No lesion recurrence or need for permanent cerebrospinal fluid diversion was detected in the patients of this series during the follow-up period.
In our experience, the interhemispheric transgenual approach has been effective in providing complete colloid cyst removal with minimal risk of vascular and parenchymal damage. Further studies are required to confirm its efficacy in improving the overall outcome of the microsurgical transcallosal approach.
第三脑室胶样囊肿是罕见的良性病变，约占颅内肿瘤的 1%。由于这些病变主要在前第三脑室生长，它们可能导致 Monro 孔阻塞，产生梗阻性脑积水。对于大囊肿和/或有症状的患者，手术是必需的。在胶样囊肿手术中描述的不同手术策略中，经胼胝体入路的显微手术仍然是许多中心的首选方法。在本研究中，我们描述了一种改良的经胼胝体入路，即间脑间入路，对 13 例连续接受第三脑室胶样囊肿手术的患者进行了研究。
所有手术均由资深作者（V.E.）在意大利波扎利的 Neuromed 研究所进行。手术过程按其各个步骤进行描述，比较了与传统经胼胝体入路相比的差异和潜在优势。
术后无手术并发症或新发神经功能缺损。术后磁共振成像证实所有病例均完全切除病变，无实质损伤迹象。在本系列患者的随访期间，未发现病变复发或需要永久性脑脊液引流。
根据我们的经验，间脑间入路在提供完全切除胶样囊肿的同时，最大限度地减少了血管和实质损伤的风险，是有效的。需要进一步的研究来证实其在改善经胼胝体入路的整体效果方面的有效性。
