Cao Lei, Wu Wentao, Kang Jie, Qiao Hui, Yang Xiaocui, Bai Jiwei, Zhu Haibo, Zhang Yazhuo, Gui Songbai
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Front Oncol. 2021 Dec 8;11:761281. doi: 10.3389/fonc.2021.761281. eCollection 2021.
The trans lamina terminalis approach (TLTA) has been described as a way to remove third ventricular tumors. The aim of this paper was to analyze the feasible outcomes of TLTA applied to tumors extending into the third ventricle in our institute.
Suprasellar tumors (n = 149) were treated by the extended endonasal approach from September 2019 to December 2020 in Beijing Tiantan Hospital. Eleven of the tumors were treated by TLTA or TLTA the trans-chiasm-pituitary corridor (TCPC). The surgical technique notes of TLTA were described and indications and outcomes of the approach were analyzed.
There were 11 patients enrolled in the study, six with papillary craniopharyngiomas, two with adamantinomatous craniopharyngiomas, one with a germinal cell tumor (GCT), one with cavernous malformation and one with chordoid glioma. Four of the patients received a radical resection by TLTA alone, while seven of them received TLTA the TCPC. Gross total resection was achieved in eight patients (72.7%), and partial resection in three patients (27.3%). Visual function was improved in four of the 11 patients (36.4%), was unchanged in five patients (45.5%), and deteriorated in two patients (18.2%). New-onset hypopituitarism occurred in seven patients (63.3%) and new-onset diabetes insipidus occurred in two patients (18.2%). Electrocyte imbalance were observed in six patients (54.5%) at post-operative week 2. There were no surgery-related deaths or cerebrospinal fluid leaks. Postoperative intracranial infection was observed in one patient (9.1%), and during the follow-up period, tumor recurrence occurred in one patient (9.1%).
The expanded TLTA provides a feasible suprachiasm corridor to remove tumors extending into the third ventricle, especially for craniopharyngiomas. Sound understanding of the major strengths and limitations of this approach, as well as strategies for complication avoidance, is necessary for its safe and effective application.
经终板池入路（TLTA）已被描述为一种切除第三脑室肿瘤的方法。本文旨在分析在我院应用TLTA治疗延伸至第三脑室肿瘤的可行性结果。
2019年9月至2020年12月，北京天坛医院采用扩大经鼻入路治疗鞍上肿瘤（n = 149例）。其中11例肿瘤采用TLTA或经视交叉 - 垂体通道（TCPC）的TLTA治疗。描述了TLTA的手术技术要点，并分析了该入路的适应证和结果。
本研究共纳入11例患者，其中6例为乳头型颅咽管瘤，2例为造釉型颅咽管瘤，1例为生殖细胞肿瘤（GCT），1例为海绵状畸形，1例为脊索样胶质瘤。4例患者仅通过TLTA进行了根治性切除，7例患者接受了TLTA联合TCPC。8例患者（72.7%）实现了全切除，3例患者（27.3%）为部分切除。11例患者中有4例（36.4%）视力功能改善，5例（45.5%）不变，2例（18.2%）恶化。7例患者（63.3%）出现新发垂体功能减退，2例患者（18.2%）出现新发尿崩症。术后第2周，6例患者（54.5%）观察到电解质失衡。无手术相关死亡或脑脊液漏。1例患者（9.1%）发生术后颅内感染，随访期间1例患者（9.1%）肿瘤复发。
扩大的TLTA为切除延伸至第三脑室的肿瘤提供了一条可行的视交叉上通道，尤其适用于颅咽管瘤。要安全有效地应用该入路，必须充分了解其主要优势和局限性以及避免并发症的策略。
