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Masses in the third and lateral ventricles
Thursday, /0 July /99 7
Tumours ofthe eNS - Ventricular, Pineal and Brainstem Tumors
established which is based on the radiobiological effects of BNCT in healthy tissue and distribution of the boron drug - Na2B' 2Hl1SH (BSH) in patients. Primary goal of the study is the investigation of possible adverse events due to BNCT, in a group of patients where poss ible benefits on survival and quality of life can be observed. Patients eligible for the study must be between 50 and 70 years old. The tumor must be diagnosed as glioblastoma multiforme and must be removed grossly. The Karnofsky performance level must be 70 or higher. This group of patients had a median survival with conventionai radiotherapy of 10-11 months . Possible adverse effects on brain tissue due to radiotherapy can therefore be observed. The treatment is delivered in four equal fractions, maintaining an average and constant boron concentration in blood. Groups 01 len patients are treated per dose group. The starting dose is set at 80% of the dose where neurological effects were seen in preclinical studies following a single fraction. Following observation of the patients for at least six months, the dose will be increased if no neurological symptoms related to the treatment are seen. The protocol will be activated in 1997.
Thursday, 10 July 1997
14:00-16:15
P-5 Tumours of the eNS - Ventricular, Pineal and Brainstem Tumors
IP-5-570 I Masses in the third and lateral ventricles O. de Jesus . Universityof Puerto Rico, San Juan, Puerto Rico Introduction: Masses in the third and lateral ventricles are uncommon therefore, only small series had been reported. A large series is presented and reviewed according to epidemiology, presentation , localization, surgical procedure, and biological behavior. Methods: Thirty-eight patients with intraventricular masses diagnosed and managed at our hospital during a seven-year period were studied retrospectively. There were 16 pediatric case s and 22 adult cases. ReSUlts: The most frequent neoplasm was oligodendroglioma. Arteriovenous mafformations were the most common non-neoplastic mass. Headache secondary to increased intracranial pressure was the most common symptom. Masses were most common ly found in the lateral ventricles except colloid cysts and craniopharyngiomas. The lateral ventricle was mainly approach through a frontal transcortical route or an anterior transcallosal route. The third ventricle was mainly approached through the lamina terminalis. Masses in the lateral ventricles were resected subtotally in 59% of the times, while those in the third ventricle were resected subtotally in 36% of the times. Those masses involving both locations were resected subtotally in 67% of the times. Sixty percent of the patients presented with hydrocephalus . Half of them required a shunt before their major surgery, while 17% required it subsequently. There was no surgical mortality in this series . Seizures occurred in 27% of the patients, always associated with a transcortical approach. Neoplas ms received radiation therapy 50% of the times and chemotherapy 14% of the times. Conclusions: Treatment options depend on the location of the mass. Recurrence is more common in pediatric cases, although their prognosis is better, Seizures are not associated with transcall osal surgery. One third of the patients with hydrocephalus never required a shunt. Chemotherapy is reserved primarily for pediatric cases in which radiotherapy could not be given.
IP-5-571 I Colloid cyst of the third ventricle T. Donrnez, M.N. Arda, A. Yurt, H. Kayak, N. Oral, Z. $ekerci . A. Turker, Social
Security Hospital Department of NeurosurgeryAnkara, Turkey Colloid cyst of the third ventricle comprises less than 2% of all brain tumours. It can be very easily diagnosed without using invasive diagnostic techniques. From 1987 to 1996,14 patients with colloid cyst of third ventricle were operated on. (11 males. 3 females). The youngest patient was 24 years old, the oldest was 60 (Average age: 41). The most common symptom was headache . Neurologic investigation reo vealed papiledema in 11 (78%), mental disorder in 2 (14%), optic atrophy in 2 (14%), ataxia in 2 (2%), tremor in 1 (7%), of the cases . One patient was normal. We performed computed tomography (CT) in 5 cases, magnetic resonance imaging (MRI) in 3 cases, and CT with MRI in 6 cases. All patients were operated: 9 by the anterior transcallosal approach and 5 by the transcortical transventricular approach . In all patients total excision of
S233
the lesion was achieved. There was no mortality. One of the patients developed intracerebral haematoma on the first postoperative day. The haematoma was evacuated immediately and the patient improved. One of the patients developed subdural haematoma on the first postoperative day, but improved . In our series, none of the cases had postoperative epilepsy. There was no recurrence during 9 years follow up. For microsurgical removal of colloid cysts of the third ventricle the transcallosal and transcortical approaches are the most effective procedures. Both procedures have advantages and disadvantages.
IP-5-572I Tumours in and around the anterior third ventricle Mostafa H. Fathy, Dep of Neurosurgery. Alexandria FaCUlty 01Medicine,
Alexandria, Egypt Tumours in and around the anterior third ventricle are variable with regard to pathology and extension. Initial surgical route for tumour exposure, and subcorridors utilised for resection of the deep parts are widely variable . A personal series of 68 such tumours were operated upon by the author during the last ten years. The series includes 9 colloid cysts 44 craniopharyngiomas, 7 optic nerve gliomas, 2 arachnoid cysts, 4 ependymoma s, and 2 ectopic pinealomas. An elaborate photomicrography of the detailed surgical technique, exposure, resection procedure and access ability are clearly illustrated for tumours of various pathological types at different sites. The transcallosal approach was used in 26 cases, pterional exposure in 21 cases and a combined approach in 19 cases. Total tumour resection was achieved in 46. Cases as was evident in P.O. CT or MRI. Three patients died, two suffered severe morbidity. The usefulness and limitations of the different exposures will be outlined utility.
IP-5-573I treatment Cysts of the anterior third ventricle: Surgical Brahm Prakash. Lions Neuro Centre, New Delhi, India Twenty five cases of cysts situated in the anterior third ventricle were treated by surgery. All the patients presented with generalised symptoms and signs of raised intracranial pressure. There was no focal sensory-motor deficit. The situation and nature of cysts was discernible on contrast C.T. Scan and Magnetic resonance imaging. Solitary intraventricular cystice rcus was found in five of twenty five cases and twenty patients had a colloid cyst in the anterio r third ventricle. The surgical approach to the anterior third ventricle depended on the presence and severity of obstructive hydrocephalus. If there was gross hydrocephalus then a right transfrontal approach was carried out, otherwise the anterior transcallosal approach was preferred . There was no mortality in both approaches. The morbidity was long in the transcallosal approach. With the transfrontal approach the morbidity was remarkably reduced except in one patient who developed a temporary amnes ic syndrome.
IP-5-574I
Occipital transtentorial approach for the pineal region tumor in concorde position and staged surgery
M. Hokama, K. Mastuo 1, S. Kobayash i, T. Tada, K. Kyoshima 2. ' Department
of Neurosurgery. Shinonoi General Hospital. Japan, 2 SHINSHU University Nagano, Japan Introduction: We have usually operated on the pineal region tumor by the infratentorial supracerebellar approach in Concorde position. However, difficult surgical cases were encountered with this approach , especially in large pineal region tumors with caudal or lateral extension. Recently, we select the approach depending on the size or location of the tumor. Th e occipital transtento rial (OTT) approach in Concorde position was selected in 8 cases and staged surgery by approach was done in 2 cases. We discuss our surgical the bilateral approach in Concorde position and advantages of staged procedure in the approach. surgery by the bilateral Method: The study was performed by the analysis of 8 surgical case s approach. The patients were placed in Concorde position. operated on by One of the advantages of the Concorde position is the flexibility of the surgeon's position, moving from the back side of the patient to the parietal side. The Sugita head frame and operating table were used; the system allowed for intraoperative head rotation. In 2 large tumors , staged surgery by the bilateral OTT approach was selected. Results: The complications of our surgical cases were only transient upper gaze disturbance in 3 cases. Removal rate of the tumor was approximately 90%. The residual tumors were mainly located at the contralateral side of the approach and in the infrasplenial region. Two large pineal region tumors, mixed germ cell tumor and ependymoma, were removed for over 95% by the staged
on on on
on
Tumours ofthe eNS - Ventricular, Pineal and Brainstem Tumors
established which is based on the radiobiological effects of BNCT in healthy tissue and distribution of the boron drug - Na2B' 2Hl1SH (BSH) in patients. Primary goal of the study is the investigation of possible adverse events due to BNCT, in a group of patients where poss ible benefits on survival and quality of life can be observed. Patients eligible for the study must be between 50 and 70 years old. The tumor must be diagnosed as glioblastoma multiforme and must be removed grossly. The Karnofsky performance level must be 70 or higher. This group of patients had a median survival with conventionai radiotherapy of 10-11 months . Possible adverse effects on brain tissue due to radiotherapy can therefore be observed. The treatment is delivered in four equal fractions, maintaining an average and constant boron concentration in blood. Groups 01 len patients are treated per dose group. The starting dose is set at 80% of the dose where neurological effects were seen in preclinical studies following a single fraction. Following observation of the patients for at least six months, the dose will be increased if no neurological symptoms related to the treatment are seen. The protocol will be activated in 1997.
Thursday, 10 July 1997
14:00-16:15
P-5 Tumours of the eNS - Ventricular, Pineal and Brainstem Tumors
IP-5-570 I Masses in the third and lateral ventricles O. de Jesus . Universityof Puerto Rico, San Juan, Puerto Rico Introduction: Masses in the third and lateral ventricles are uncommon therefore, only small series had been reported. A large series is presented and reviewed according to epidemiology, presentation , localization, surgical procedure, and biological behavior. Methods: Thirty-eight patients with intraventricular masses diagnosed and managed at our hospital during a seven-year period were studied retrospectively. There were 16 pediatric case s and 22 adult cases. ReSUlts: The most frequent neoplasm was oligodendroglioma. Arteriovenous mafformations were the most common non-neoplastic mass. Headache secondary to increased intracranial pressure was the most common symptom. Masses were most common ly found in the lateral ventricles except colloid cysts and craniopharyngiomas. The lateral ventricle was mainly approach through a frontal transcortical route or an anterior transcallosal route. The third ventricle was mainly approached through the lamina terminalis. Masses in the lateral ventricles were resected subtotally in 59% of the times, while those in the third ventricle were resected subtotally in 36% of the times. Those masses involving both locations were resected subtotally in 67% of the times. Sixty percent of the patients presented with hydrocephalus . Half of them required a shunt before their major surgery, while 17% required it subsequently. There was no surgical mortality in this series . Seizures occurred in 27% of the patients, always associated with a transcortical approach. Neoplas ms received radiation therapy 50% of the times and chemotherapy 14% of the times. Conclusions: Treatment options depend on the location of the mass. Recurrence is more common in pediatric cases, although their prognosis is better, Seizures are not associated with transcall osal surgery. One third of the patients with hydrocephalus never required a shunt. Chemotherapy is reserved primarily for pediatric cases in which radiotherapy could not be given.
IP-5-571 I Colloid cyst of the third ventricle T. Donrnez, M.N. Arda, A. Yurt, H. Kayak, N. Oral, Z. $ekerci . A. Turker, Social
Security Hospital Department of NeurosurgeryAnkara, Turkey Colloid cyst of the third ventricle comprises less than 2% of all brain tumours. It can be very easily diagnosed without using invasive diagnostic techniques. From 1987 to 1996,14 patients with colloid cyst of third ventricle were operated on. (11 males. 3 females). The youngest patient was 24 years old, the oldest was 60 (Average age: 41). The most common symptom was headache . Neurologic investigation reo vealed papiledema in 11 (78%), mental disorder in 2 (14%), optic atrophy in 2 (14%), ataxia in 2 (2%), tremor in 1 (7%), of the cases . One patient was normal. We performed computed tomography (CT) in 5 cases, magnetic resonance imaging (MRI) in 3 cases, and CT with MRI in 6 cases. All patients were operated: 9 by the anterior transcallosal approach and 5 by the transcortical transventricular approach . In all patients total excision of
S233
the lesion was achieved. There was no mortality. One of the patients developed intracerebral haematoma on the first postoperative day. The haematoma was evacuated immediately and the patient improved. One of the patients developed subdural haematoma on the first postoperative day, but improved . In our series, none of the cases had postoperative epilepsy. There was no recurrence during 9 years follow up. For microsurgical removal of colloid cysts of the third ventricle the transcallosal and transcortical approaches are the most effective procedures. Both procedures have advantages and disadvantages.
IP-5-572I Tumours in and around the anterior third ventricle Mostafa H. Fathy, Dep of Neurosurgery. Alexandria FaCUlty 01Medicine,
Alexandria, Egypt Tumours in and around the anterior third ventricle are variable with regard to pathology and extension. Initial surgical route for tumour exposure, and subcorridors utilised for resection of the deep parts are widely variable . A personal series of 68 such tumours were operated upon by the author during the last ten years. The series includes 9 colloid cysts 44 craniopharyngiomas, 7 optic nerve gliomas, 2 arachnoid cysts, 4 ependymoma s, and 2 ectopic pinealomas. An elaborate photomicrography of the detailed surgical technique, exposure, resection procedure and access ability are clearly illustrated for tumours of various pathological types at different sites. The transcallosal approach was used in 26 cases, pterional exposure in 21 cases and a combined approach in 19 cases. Total tumour resection was achieved in 46. Cases as was evident in P.O. CT or MRI. Three patients died, two suffered severe morbidity. The usefulness and limitations of the different exposures will be outlined utility.
IP-5-573I treatment Cysts of the anterior third ventricle: Surgical Brahm Prakash. Lions Neuro Centre, New Delhi, India Twenty five cases of cysts situated in the anterior third ventricle were treated by surgery. All the patients presented with generalised symptoms and signs of raised intracranial pressure. There was no focal sensory-motor deficit. The situation and nature of cysts was discernible on contrast C.T. Scan and Magnetic resonance imaging. Solitary intraventricular cystice rcus was found in five of twenty five cases and twenty patients had a colloid cyst in the anterio r third ventricle. The surgical approach to the anterior third ventricle depended on the presence and severity of obstructive hydrocephalus. If there was gross hydrocephalus then a right transfrontal approach was carried out, otherwise the anterior transcallosal approach was preferred . There was no mortality in both approaches. The morbidity was long in the transcallosal approach. With the transfrontal approach the morbidity was remarkably reduced except in one patient who developed a temporary amnes ic syndrome.
IP-5-574I
Occipital transtentorial approach for the pineal region tumor in concorde position and staged surgery
M. Hokama, K. Mastuo 1, S. Kobayash i, T. Tada, K. Kyoshima 2. ' Department
of Neurosurgery. Shinonoi General Hospital. Japan, 2 SHINSHU University Nagano, Japan Introduction: We have usually operated on the pineal region tumor by the infratentorial supracerebellar approach in Concorde position. However, difficult surgical cases were encountered with this approach , especially in large pineal region tumors with caudal or lateral extension. Recently, we select the approach depending on the size or location of the tumor. Th e occipital transtento rial (OTT) approach in Concorde position was selected in 8 cases and staged surgery by approach was done in 2 cases. We discuss our surgical the bilateral approach in Concorde position and advantages of staged procedure in the approach. surgery by the bilateral Method: The study was performed by the analysis of 8 surgical case s approach. The patients were placed in Concorde position. operated on by One of the advantages of the Concorde position is the flexibility of the surgeon's position, moving from the back side of the patient to the parietal side. The Sugita head frame and operating table were used; the system allowed for intraoperative head rotation. In 2 large tumors , staged surgery by the bilateral OTT approach was selected. Results: The complications of our surgical cases were only transient upper gaze disturbance in 3 cases. Removal rate of the tumor was approximately 90%. The residual tumors were mainly located at the contralateral side of the approach and in the infrasplenial region. Two large pineal region tumors, mixed germ cell tumor and ependymoma, were removed for over 95% by the staged
on on on
on