| Objective: To explore the individualized design of minimally invasive keyholeapproaches and evaluate the clinical efficacy of microsurgical excision of the thirdventricle tumors.Methods: There were64cases whose tumors were located in or extended into thethird ventricle in the neurosurgical department of the second affiliated hospital of SoochowUniversity from August2000to August2013. According to the characteristics and thegrowth patterns of the lesions, superciliary arch keyhole approach, infratentorialsupracerebellar keyhole approach, interhemispheric transcallosal keyhole approach,pterional keyhole approach and occipital keyhole approach were designed to enter the thirdventricle anteriorly, posteriorly, superiorly or laterally. We made sure that there was noobstructive hydrocephalus of the third ventricle when the tumor was resected.Results: Total tumor resection was done in51cases (79.69%), and subtotal resectionin13cases (20.31%), and there was no operative mortality. No extended incision orenlarged bone flap were performed because of episode during operation or inadequateexposure. The incidence rates of diabetes insipidus, vision and visual field deterioration inanterior keyhole approaches, cerebellar swelling in infratentorial supracerebellar keyholeapproaches, postoperative intracranial hemorrhage, intracranial infection, consciousnessdisturbance, CSF (cerebrospinal fluid) leakage in all keyhole approaches were8.70%,8.70%,7.69%,3.13%,3.13%,1.56%and1.56%, respectively. No complications such asepilepsy and brain contusion caused by brain retraction occurred.37cases suffered fromhydrocephalus before operation, which improved or disappeared in36cases after operation,and only1case underwent lumbar-peritoneal shunt because of communicatinghydrocephalus. Conclusions:1. Microsurgery keyhole approaches are safe, minimally invasive and effectivetreatment for the excision of the third ventricle tumors and can resolve hydrocephalus.2. Individualized keyhole approach ensured the success of surgical treatment of thethird ventricle tumors. Interhemispheric transcallosal keyhole approach was appropriate fortumors located in the central and superior part of the third ventricle; infratentorialsupracerebellar keyhole approach was suitable for the third ventricle tumors in theposterior region; occipital keyhole approach was useful for tumors located in the lateralwall of the third ventricle; superciliary arch and pterional keyhole approaches wereapplicable for tumors of the anterior third ventricle, and superciliary arch keyhole approachwas more helpful when exposing deep portion of the third ventricle. |
