Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India.
Department of Neurosurgery, MS Ramaiah Medical College and Hospital, MS Ramaiah Nagar, Mathikere, Bengaluru, Karnataka, India.
Neurol India. 2022 Jul-Aug;70(4):1417-1426. doi: 10.4103/0028-3886.355141.
Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV).
To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV.
Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011-May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots.
Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions.
Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.
对于第三脑室后部（PTV）区域肿瘤的理想手术入路存在争议。
评估经枕叶间脑幕下入路（OITT）治疗 PTV 肿瘤的结果。
在 5 年的研究期间（2011 年 6 月至 2016 年 5 月），斯里萨蒂亚赛高等医学科学研究所的 33 名患者接受了 OITT 入路治疗 PTV 肿瘤的手术。通过神经导航确定 OITT 入路的理想轨迹。使用内窥镜切除盲点处的任何残留病变。
所有患者术后磁共振成像（MRI）显示 31 例（93.9%）肿瘤大体全切除或近全切除（>95%）。15 例患者中有 73.3%（11/15）的术前神经功能缺损在肿瘤切除后完全或显著改善。93.9%（31/33）的患者出院时预后良好（改良 Rankin 量表≤2），96.8%（30/31）的患者在 3 个月或更长时间的最终随访时预后良好。术后无患者死亡。并发症包括上视麻痹（一过性-6.1%[2/33]，持续性-3%[1/33]）、视野缺损（一过性-3%[1/33]，持续性-3%[1/33]）、短暂性动眼神经麻痹（1/33-3%）、短暂性偏瘫（1/33-3%）、手术部位血肿（1/33-3%）、小后循环动脉（PCA）区梗死（1/33-3%）和小静脉梗死（1/33-3%）。23 例患者中至少进行了一次随访 MRI。20 例患者（20/23-87%）的最终随访 MRI 显示与术后图像相比无复发或残留病变增大，3 例（3/23-13%）高级别病变复发较大。
通过 OITT 入路可对大多数 PTV 肿瘤进行大体全切除/近全切除，且发病率和死亡率低。
