Introduction: Surgical resection of intraventricular tumors presents a challenge due to proximity of important neurovascular structures to these deep-seated masses. Transcortical and transcallosal approaches involve violation of normal anatomy. Here we present a single surgeon’s experience of intraventricular tumor resection through both approaches. The purpose of this study is to compare and contrast the morbidity associated with each approach given the uniformity of operative technique.
Methods: All patients who have undergone intraventricular tumor resection by the senior author from 2004 to 2013 were retrospectively analyzed. 33 patients were identified. Comparative risk of complications for each surgical approach was evaluated using the Fisher’s exact test and logistic regression.
Results: 33 patients with ages ranging from 16 to 70 years (median of 41) were operated on through transcallosal (n=19) or transcortical (n=14) approach. Greater than 90% of tumor was resected in 81.8% of patients (n=27). New onset post-operative seizures occurred in 5.2% of the transcallosal approach and 14.2% in transcortical approach (p=0.56). There is a 3-fold increase in the odds of having a seizure post-operatively in transcortical approach (95% CI of 0.24-36.88). In the immediate postoperative period, 18.2% of patients (n=6) experienced major neurovascular complications. These complications were present in 10.5% of transcallosal approach and 28% of transcortical approach (p=0.36). Only 8.3% of patients with colloid cysts (n=12) experienced a neurovascular complication compared to 23.8% with all other tumors (p=0.38). 57.8% of patients had an excellent functional outcome (KPS =70) with at least 12 month follow-up.
Conclusions: Transcallosal and transcortical approaches both lead to neurovascular complications post-operatively. In our study of a single surgeon’s experience, there is no statistically significant difference in the rate of seizures or neurovascular complications between the two approaches. Colloid cyst patients experienced the least complications. However, both approaches may be used according to neuroanatomical consideration for each patient.
Patient Care: Comparing two approaches for intraventricular tumors from the perspective of a single surgeon can inform the decision of other surgeons in choosing the ideal approach for their patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Compare post-operative complication risks of traditional approaches to intraventricular tumors 2) Discuss overall functional outcomes of these two approaches 3) Identify the tumors with the best outcome