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Romanian (2014) XXI 1: 61 - 73 61 DOI: 10.2478/romneu-2014-0006 in tumors of the lateral ventricles – last 8 years experience

Mugurel Radoi, Leon Danaila, Florin Stefanescu, Daniel Petrescu, Ram Vakilnejad Neurosurgery Clinic of the National Institute of Neurology and Neurovascular Diseases, Bucharest

Abstract Most frequent histological tumor’s type Introduction : Tumors of the lateral was , ventricle are rare lesions including a large papilloma, and . variety of benign or malignant tumors. Signs of increased These tumors could originate in the were most dominant. One patient died ventricular wall or arising and expanding because of postoperative intraventricular within the lateral ventricle from the hemorrhage. Additional neurological surrounding neural structures. The deficits were seen in 3 patients and purpose of this study is to discuss postoperative occurred in three postoperative results and factors that patients. One patient with preoperative affected the preference for transcallosal or hydrocephalus required ventriculo- transcortical approach. peritoneal shunting after tumor’s resection. Material and methods : We performed a Two patients developed postoperative retrospective study, lasted between 2005- epidural hematoma and one required 2013, that comprised 26 consecutive reoperation. 15 of 26 patients received patients who underwent operation for postoperative radiotherapy and 6 of them lateral ventricle tumors. The main clinical received adjuvant . The symptoms and signs were associated with mean duration of postoperative evaluation the localization and size of the tumors. was 24,32 (range 5-92). Excepting the cases Cerebral computed tomography and with subtotal resection, two patients were magnetic resonance imaging were used to reoperated for recurrences. determine the location and expansion of Conclusions : The nature, size, location each tumor. The transcortical approach and vascularization of intraventricular was used in 17 patients and the tumors are the most important elements transcallosal approach was used in 9 influencing the choice of surgical patients. approach. Surgeons must evaluate all these Results : Total tumor resection was factors and prefer the short and safe way to achieved in 73% of cases (19 patients). remove the tumor.

62 Radoi et al Surgery in tumors of the lateral ventricles

Introduction intraventricular tumors and their Tumors of the lateral ventricle are rare relationship to surrounding structures. lesions including a large variety of benign Microsurgical resection is the treatment or malignant tumors. Intraventricular of choice for lateral ventricle tumors. The tumors are more common in children than optimal approach depends on the location in adults, accounting for approximately 1- and size of the lesion, the size of the lateral 3% of adult tumors (4,5,9), and till ventricles, and the relationship of the 16% of childhood and adolescent to the third ventricle. The tumors (9). Of intraventricular brain transcortical or transcallosal routes afford tumors, 49% in adults are found in the the surgeon the possibility to completely lateral ventricle (9). remove most of these tumors. The location Tumors of the lateral ventricle originate of the lateral ventricles makes passing from the and subependyma that through cortical structures mandatory in line the ventricles, from the choroid plexus all approaches to these tumors (25). The arachnoid and epithelium, or from ectopic transcallosal approach may decrease the rests that have become trapped risk of postoperative and within the ventricle or its lining (2). functional deficits (2,6,26). Anterior or Tumors expanding within the ventricular posterior transcallosal approaches can be cavity cause symptoms and signs of safely used to excise tumors located in the obstruction of the normal cerebrospinal ventricular body or atrium. The fluid (CSF) pathways, compression of the transcortical approach has the advantage of adjacent neural structures, or simplicity, and became an attractive hydrocephalusinduced by overproduction alternative to the transcallosal approach for of CSF (13,14,25). many tumors located in the frontal, The most frequently encountered temporal and occipital horn and atrium pathologic diagnosis in tumors of the (19). The presence or absence of lateral ventricle, in adults, is , preoperative neurologic deficits also meningioma, ependymoma and choroid influences the surgeon’s decision in plexus papilloma (5,9,13). Other rare selecting a particular approach (4,6,8). intraventricular lesions are: We presented our clinical and surgical , subependymal giant cell data for a consecutive series of 26 patients astrocytoma, , with lateral ventricle tumors. teratoma,epidermoid tumors and metastatic carcinoma (5,11,13,20). Material and methods Magnetic resonance imaging (MRI) has Between January 2005 and August 2013 become the preferred modality for in our Neurosurgical Department of the preoperative evaluation because it provides National Institute of Neurology and the best three-dimensional images of these Neurovascular Diseases, there were 26

Romanian Neurosurgery (2014) XXI 1: 61 - 73 63 DOI: 10.2478/romneu-2014-0006 consecutive patients who underwent For tumors located in the frontal horn surgery for tumors of the lateral ventricles. neurological signs were , seizures, We performed a retrospective study that mental disturbances and high intracranial included clinical, radiological, surgical and pressure syndromes. Patients with tumors pathological data from our recordings. We located in the temporal horn or occipital included in our series neoplasms that horn developed mainly headache, motor originate in the lateral ventricle wall and sensorial deficits, visual deficits and (primary ventricular tumors) and aphasia for the dominant hemisphere. neoplasms arising in the adjacent brain Clinical symptoms and signs for tumors structures but with exophytic grow within located in the atrium included high the ventricles. Two main surgical intracranial pressure signs, mental approaches were used in tumor resection: disturbances, motor and sensorial deficits. transcortical approach (17 patients) and Preoperative computed tomography transcallosal approach (9 patients). We (CT) and magnetic resonance imaging analyzed the factors that influenced the (MRI) images, both contrast-enhanced and choice of surgical approach: location of the unenhanced, were examined to determine tumor within the third ventricle, expansion the location and expansion of each tumor, and size of the tumor, approaching from appearance and specific tissue signs dominant/non-dominant hemisphere, size characteristics. The arterial supplies of the of ventricles, postoperative residue tumor tumor, arterial and venous anatomy of the size and postoperative complications. region, were studied with cerebral The 26 patients included 14 males and angiography in 7 patients. Preoperative 12 females. The mean age at admission hydrocephalus was noted in 4 patients. was 38 years (range 17 to 69 years). There was no pediatric population in our study. TABEL I The number of males and females was The distribution of the patients accordi ng to approximately equal in all tumor the age groups and gender categories, excepting glioblastoma (male Age ( years) No of patients Male Female dominancy 3M:1F) and meningioma 0-11 0 0 0 (female dominancy 1M:4F). The 11-20 4 2 2 distribution of patients according to the 21-30 6 4 2 age and sex groups is shown in Table I. 31-40 3 1 2 Clinical depended 41-50 6 2 4 on the location of the tumor (Table II). 51-60 4 3 1 The symptoms and signs for tumors 61-70 3 2 1 located in the ventricular body were high >71 0 0 0 intracranial pressure syndromes, mental Total 26 14 12 disturbances, motor and sensorial deficits.

64 Radoi et al Surgery in tumors of the lateral ventricles

TABLE II Signs and symptoms according to the tumor location Tumor No of High IP Seizures Mental Motor Sensorial Aphasia Visual location patients signs disturbances deficits deficits deficits Ventricular 8 7 1 2 4 5 0 0 body Frontal horn 4 2 2 2 1 0 1 0 Temporal 5 3 2 0 2 2 2 1 horn Occipital 3 3 0 0 1 1 0 1 horn Atrium 5 4 0 1 1 1 1 0 Septum 1 1 0 1 1 0 0 0 Total 26 20 5 6 10 9 4 2

Localization of the lateral ventricle Results tumors were the ventricular body (8 Surgical results regarding the extent of patients), frontal horn (4 patients), tumor removal and approach used temporal horn (5 patients), occipital horn according to tumor origin are shown in (3 patients), atrium (5 patients) and Table IV. For tumors located in the frontal septum pellucidum (1 patient). The horn we used in all 4 patients the distribution according to the tumor’s transcortical middle frontal gyrus approach histology is presented in Table III. Most of (figure 1). Total excision was achieved in 2 the tumors had transependymal expansion, cases. The temporal horn tumors were mainly in the frontal and temporal horn accessed through a cortical middle and . Only choroid plexus temporal gyrus (figure 2) or papilloma and arachnoid cysts had no occipitotemporal incision. Difficulty was transependymal expansion. encountered in tumors located in In choosing the surgical approach we dominant hemisphere due to lack of took into account the location, expansion cortical stimulation and mapping. Total and the size of the tumor, whether it is in resection was achieved in 4 cases. For the dominant or non-dominant occipital horn tumors transcortical hemisphere. We used the frontal approach was used in all cases (figure 3). A transcortical approach (5 cases), temporal superior parietal cortical incision was made transcortical approach (8 cases), parietal in 2 cases, one of them in dominant transcortical approach (4 cases), anterior hemisphere, and a temporooccipital transcallosal approach (7), and posterior cortical incision was made for removing a transcallosal approach (2). . Total excision of

Romanian Neurosurgery (2014) XXI 1: 61 - 73 65 DOI: 10.2478/romneu-2014-0006 tumors was performed in all 3 cases. For tumor located in the septum pellucidum, tumors located in the body of the lateral we achieved total resection through a ventricles, anterior transcallosal approach posterior transcallosal approach. was used in most of the cases (figure 4 and figure 5). Only a frontal transcortical TABLE III approach was used for resection of a Distribution of patients depending on glioblastoma. With the exception of tumor’s histology , the other tumors did not Tumor histology No of patients exhibit transependymal extension. Subtotal Glioblastoma 4 resection was performed in 2 patients with Choroid plexus paplilloma 5 Meningioma 5 glioblastoma and total resection in 6 cases. Ependymoma 4 Tumors located in the atrium (figure 6) Oligodendrog lioma 2 were resected through a temporal or Arachnoid cysts 1 1 parietal transcortical route in 3 cases, and a Fibrilar astrocytoma 1 posterior transcallosal route was used for Subependymal giant cell 1 the excision of an arachnoid cyst. Total atrocytoma resection was achieved in 4 out of 5 Subependymoma 1 patients. For a single patient with a small 1

TABLE IV Type of approach and grade of resection of the tumors depending on their location FRONTAL HORN Hi stologic type Extension Surgical approach Grade of resection Frontal lobe F transcortical Subtotal Meningioma Frontal lobe F transcortical Total Glioblastoma Frontal lobe F transcortical Subtotal Metastasis Frontal lobe F transcortical Total TEMPORAL HORN Histologic type Extension Surgical approach Grade of resection Meningioma (2) Temporal lobe T transcortical Total Fibrilar astrocytoma Temporal lobe T transcortical Total Ependimoma Temporal lobe T transcortical Subtotal Choroid plexus papilloma No T transcortical Total VENTRICULAR BODY Histologic type Extension Surgical approach Grade of resection Glioblastoma (2) Corpus callosum F transcortical/Ant Subtotal transcallosal Ependymoma (2) No Ant transcallosal Total

66 Radoi et al Surgery in tumors of the lateral ventricles

Choroid plexus papilloma No Ant transcallosal Total (2) Oligodendroglioma No Ant transcallosal Total Subependymal giant cell No Ant transcallosal Total astrocytoma ATRIUM Histologic type Extension Surgical approach Grade of resection Ependymoma Parietal lobe P transcortical Subtotal Meningioma (2) Temporal lobe/occipital T transcortical Total lobe Choroid plexus papilloma No T transcortical Total Arachnoid cyst No Post transcallosal Total OCCIPITAL HORN Histologic type Extension Surgical approach Grade of resection Glioblastoma Parietal lobe P transcortical Total Choroid plexus papilloma No P transcortical Total Anaplastic astrocytoma Parietal lobe P transcortical Total SEPTUM PELLUCIDUM Histologic type Extension Surgical approach Grade of resection Subependymoma No Post transcallosal Total F,T,P transcortical – frontal, temporal, parietal transcortical approach; ant/post transcallosal – anterior or posterior transcallosal approach.

Total tumor resection was achieved in hemorrhage was noted in 2 patients who most of the benign or low-grade tumors, needed immediate re-operation. Epidural and subtotal resection was performed postoperative hematoma needing mainly in patients with malignant tumors. reoperation was recorded for a patient with From 26 patients who underwent surgery, choroid plexus papilloma, and ventriculo- total resection was achieved in 73% (19 peritoneal shunt application was patients). We performed subtotal resection performed for a patient with glioblastoma in 6 patients: 3 with glioblastoma, 2 with and no preoperative hydrocephalus. A ependymoma and one with small subdural hematoma occurred in one oligodendroglioma. patient and required no treatment. One patient with ependymoma died 12 Additional neurological deficits were seen days after initial surgery because of in 3 patients. Postoperative seizure intraventricular hemorrhage. The occurred in 2 patients with postoperative complications are presented oligodendroglioma and, respectively, in Table V. Postoperative intraventricular meningioma. No additional visual defects

Romanian Neurosurgery (2014) XXI 1: 61 - 73 67 DOI: 10.2478/romneu-2014-0006 were seen. Choroid plexus 5 Epidural hematoma and 15 out of 26 patients received papilloma reoperation (1) postoperative radiotherapy and 6 of them Ependymoma 4 Intraventricular hemorrhage and death received adjuvant chemotherapy. The (1); no complication (3). mean duration of postoperative evaluation Meningioma 5 Brain edema (1); seizure was 24.31 months (range 5 to 92 months). (1) Shortest follow-up period was recorded in Oligodendroglioma 2 Seizure (1) glioblastoma patients with 5, 8 and, Arachnoid cyst 1 No complication respectively 11 months. Long periods of Anaplastic 1 Additional neurological follow-up were encountered in patients astrocytoma deficits (1) with meningioma: 84 and, respectively, 92 Fibrilar astrocytoma 1 No complication Subependymal giant 1 No complication months, and choroid plexus papilloma cell astrocytoma with 72 months of follow-up. At the end of Subependymoma 1 No complication follow-up, there were no recurrences or Metastasis 1 No complication increased in tumor sizes in meningioma, choroid plexus papilloma, subependymal giant cell astrocytoma, subependymoma and arachnoid cyst. The maximum recurrences and increased tumor size were seen in glioblastoma. Excepting the cases with subtotal resection, 2 patients with recurrences were reoperated (ependymoma and anaplastic astrocytoma).

TABLE V Number of postoperative complications related to the tumor’s histology and initial number of patients Tumor type No of Postoperative patients complications Glioblastoma 4 Intraventricular hemorrhage and Figure 1 reoperation (1); Metastasis developed in the frontal horn of the left ventriculo-peritoneal lateral ventricle and expanding in ipsilateral frontal application (1); additional lobe; preoperative and postoperative contrast CT neurological deficits (2); scan; left transcortical middle frontal gyrus approach; total resection. no complication (2).

68 Radoi et al Surgery in tumors of the lateral ventricles

Figure 3 Anaplastic astrocytoma developed in the occipital horn of the right lateral ventricle; preoperative and 2 months postoperative CT scan; approach through a right parietal transcortical route; total resection.

Figure 2 Fibrilar astrocytoma developed in the temporal horn of the right lateral ventricle; preoperative contrast MRI and postoperative contrast CT scan; right cortical middle temporal gyrus approach; total resection.

Figure 4 Subependymal giant cell astrocytoma developed in the ventricular body; preoperative and postoperative MRI; anterior transcallosal approach; total resection.

Romanian Neurosurgery (2014) XXI 1: 61 - 73 69 DOI: 10.2478/romneu-2014-0006

(4,7). In our study there were not pediatric patients. The youngest patient was 18 years old at the time of surgery. The number of males and females was approximately equal in all tumor

categories, excepting glioblastoma (male dominancy 3M:1F) and meningioma (female dominancy 1M:4F). Tumors of the lateral ventricle most often grow very large before they become clinically manifest. In order of decreasing Figure 5 frequency they occur in the frontal horns, Ependymoma developed in the ventricular body; ventricular body and atrium (1). In preoperative and postoperative (14 days after surgery) cerebral CT scan; anterior transcallosal another series, the most common approach; total resection. localizations of lateral ventricle tumors were atrium, frontal horn, ventricular body and temporal horn (10). Goklap et al (5) reported 112 lateral ventricle tumors in their study, and the most frequent sites of the tumors were the frontal horn, body and the atrium. In our series, the incidence of tumor localization within the lateral

ventricles in descending order of frequency was reported as ventricular body (30.76%), atrium (19.23%), temporal horn (19.23%) and frontal horn (15.38%).

Figure 6 Neoplasms that originate in the Meningioma developed in the atrium of the lateral ventricular wall and its lining are ventricles; preoperative and postoperative MRI; left considered primary ventricular tumors, temporooccipital transcortical approach; total and, the majority of these are benign or resection. low-grade lesions (meningioma, choroid plexus papilloma, ependymoma) (14,16). Discussions Tumors that arise in the adjacent brain The histopathologic diagnosis of the structures with important exophytic lateral ventricle tumors varied with the age growth within the ventricle are considered of the patients (5,12). In children, these secondary ventricle tumors with tumors were often choroid plexus tumors, transependymal development, and they are whereas in adults they tended to be commonly gliomas (3). In this report, the

70 Radoi et al Surgery in tumors of the lateral ventricles most frequent tumor types were The transcortical approach to the meningioma (19.23%), choroid plexus temporal horn is the best method to papilloma (19.23%), glioblastoma remove lesions in this area. This approach (15.38%) and ependymoma (15.38%). provides a short trajectory to the tumor. In The best surgical approach to the the non-dominant hemisphere, this is a tumors of the lateral ventricles is that very acceptable route, causing minimal which offers the shortest distance to the morbidity. We used the middle temporal lesion with a perpendicular field of view, gyrus approach, on the non-dominant requires minimal retraction of the brain, hemisphere, to totally remove 2 tumors avoids trajectory through functional located in the temporal horn and 2 in the structures and provides clear visualization atrium. In the dominant hemisphere, the of the vascular feeding branches (24). presence of the language cortex represents Surgical approaches to the lateral ventricles an important issue. In such cases, this could be summarized as follow: (1) approach requires careful dissection and anterior approaches: anterior transcortical retraction, refinement in techniques and and anterior transcallosal, (2) posterior the use of cortical stimulation and approaches: posterior transcortical and mapping (19). On the left hemisphere, we posterior transcallosal, (3) temporal and used this approach in 3 cases and achieved subtemporal transventricular approaches, total resection with minimal postoperative inferior posterior frontotemporal (25). Due aphasia. to microsurgical techniques we achieved The superior parietal approach is very total resection of the tumor in 73% (19 suitable for reaching tumors located in the patients). posterior part of the ventricular body and In this series, transcortical middle atrium, especially for large masses with a frontal gyrus approach was used in 5 superior development (4,5). Cortical patients for resection of tumors in the incision should be performed high enough ipsilateral frontal horn or the anterior to avoid visual field, because calcarine ventricular body. Most of these tumors gyrus is adjacent to the medial wall of the were large and cause obstruction of the atrium. Because the vascular supply to the foramen of Monro. In such cases, is tumor is deep, this approach did not important to locate the foramen of Monro provide access to vascular control before and avoid the damage of the fornix (25). tumor removal. We safely performed this This approach is facilitated when the approach in the 4 tumors, two of them lateral ventricles are enlarged. In our located in the dominant hemisphere. We series, 3 out of 5 tumors operated with this achieve total resection of 3 tumors in the approach were resected subtotally, two of occipital horn, and a subtotal resection for them being glioblastoma multiformes. an ependymoma located in the atrium.

Romanian Neurosurgery (2014) XXI 1: 61 - 73 71 DOI: 10.2478/romneu-2014-0006 The transcallosal approaches to the was noted in 4 patients, but we performed lateral ventricle tumors was performed in 9 shunt application in one patient who had a cases in our series. There are several bifrontal glioblastoma and was operated by advantages of these approaches over the the anterior transcallosal approach. The transcortical route: reduce the risk of brain number of patients requiring a shunt vary injury with appropriate brain relaxation based on different factors (19). and minimal retraction, reduce the risk of Approximately 10% to 50% of patients postoperative porencephalic cyst and will ultimately required subdural hygroma formation, low risk of diversion (15). postoperative seizures, low risk of The reported incidence of postoperative functional deficits, need normal sized seizures after transcortical approaches ventricles (18,22). In the anterior varied widely from 19% to 75% (3,4). In transcallosal approach, the callosal section our series, there were 5 patients who must spare the genu of the corpus experienced postoperative seizures callosum, especially near the rostrum and (19.23%), but only two of them required the anterior commissure anteriorly, and prolonged antiepileptic treatment, operated the posterior part of the sectioned callosum using a frontal, respectively, temporal must not go beyond the interparietal transcortical approach. commissure (23). As reported in the In this series, the authors reported a literature, the large tumors of the occipital low mortality rate of 3.84%, meaning that horn and atrium were not suitable for one out of 26 patients died secondary to an posterior transcallosal resection, as the important postoperative intraventricular tumor itself prevented the hemispheric hemorrhage. The deaths in the last decades retraction that is required to achieve tumor reported series are lower than 10% and are removal, and for proper choroidal vessel usually due to severe postoperative control (17). In our series, the anterior hemorrhage or pulmonary emboli (5,6,15). transcallosal approach was used in 7 cases of tumors located in the ventricular body. Conclusions Total tumor removal was achieved in all Tumors of the lateral ventricles are rare, cases, except one patient with a deep-seated lesions, relatively slow growing glioblastoma multiforme. All tumors had and can became larger before causing small or medium size (not larger than 35 symptoms. Because of their large size the mm.). The posterior transcallosal approach treatment is surgical resection. The was used for resection of an arachnoid cyst selected approach must take into account from the atrium and a small ependymoma the size, location, expansion, from the septum pellucidum. vascularization, the critical brain structures In 65.5% cases we had no postoperative nearby the tumor and the consequent complications. Preoperative hydrocephalus neurologic sequelae. Our goal was

72 Radoi et al Surgery in tumors of the lateral ventricles complete resection of the tumor using Lateral ventricular neoplasms of the brain: Differential diagnosis based on clinical, CT, and, MRI findings. AJR microsurgical techniques, but when the 155:365-372, 1990. tumor was malignant or attached to 8.Kasowski H, Piepmeier JM. Transcallosal approach for eloquent structures, subtotal resection was tumors of the lateral and third ventricles. Neurosurg Focus 10 (6): Article (3), 2001. preffered. There were no significant 9.Koos WT, Miller MH. Tumors of the ventricular differences in complications between the system. In: Koos WT, Miller MH. Intracranial tumors of transcortical and transcallosal approaches. infants and children. Stuttgart: Verlag, 1970:233-253. Finally, we can conclude that the surgeon 10.Lapras C, Deruty R, Bret PH. Tumors of the lateral ventricle. In: Symon L, eds. Advances and Technical should prefer the shortest, most familiar Standards in Neurosurgery. Wien-New York: Springer- and the most safe way in removing a Verlag, 1984. lateral ventricle tumor. 11.Nishito S, Fujiwara S, Tashima J, Takheshita I, Fuji K, Fukui M. Tumors of the lateral ventricular wall, especially the septum pellucidum: Clinical presentation, Corresponding author: and variations in pathological features. Neurosurgery 27: 224-230, 1990. Dr. Radoi Mugurel 12.Osborn AG. Diagnostic Neuroradiology. St Louis, E-mail address: [email protected] Mosby; 1994: 401-528. Tel: 0723527292 13.Pendl G, Ozturk E, Haselberger K. Surgery of tumors of the lateral ventricle. Acta Neurochir 116:128- 136, 1992. References 14.Piepmeier JM, Sass KJ. Surgical management of 1.Abosch A, McDermott WM, Wilson CB. Lateral lateral ventricular tumors. In: Paoletti P, Takakura K, ventricular tumors. In: Kaye AH and Black PMcL , eds. Walker M, eds. Neuro-Oncology, Dordecht. Kluwer Operative Neurosurgery. London-New York –Sydney: Academic Publishers, 1991: 333-335. Churchill Livingstone 2000, pp. 799-814 15.Piepmeier JM, Spencer DD, Sass K: Lateral 2.Apuzzo ML, Chikoyani OK, Gott PS, Teng EL, Zee ventricular masses. In: Apuzzo MLJ, eds. Brain Surgery: CS, Giannotta SL, Weiss MH. Transcallosal, Complication Avoidance and Management. New York, interfornicial approaches for lesions affecting the third Churchill Livingstone, 1993: 581-599. ventricle: surgical considerations and consequences. 16.Piempier JM, Westerveld M, Spencer DD, Sass K. Neurosurgery 10:547-554, 1982 surgical management of intraventricular tumors of the 3.D’Angelo VA, Galarza M, Catapano D, Monte V, lateral ventricle. In: Schimdek HH, Sweet WH, eds. Bisceglia M, Carosi E. Lateral ventricle tumors: surgical Operative Neurosurgical Techniques. Indications, strategies according to tumor origin and development – Methods and Results. Philadelphia: W.B Saunders a series of 72 cases. Neurosurgery 56 (Suppl 1): 36-45, Company, 1995: 725-738. 2005. 17.Rabb CH, Apuzzo MLJ. Options in the management 4.Ellenbogen RG. Transcortical surgery for lateral of ventricular masses. In: Tindall GT, Cooper PR, ventricular tumors. Neurosurg, Focus 10(6): Article 2, Barrow DL, eds. The Practice of Neurosurgery. 2001. Baltimore: Williams αWilkins, 1996, 1229-1242. 5.Gokalp HZ, Yuccer N, Arasil E, Deda H, Attar A, 18.Rhoton AL Jr. The lateral and third ventricles. Erdogan A, Egmen N, Kanpolat Y. Tumors of the lateral Neurosurgery 51 (Suppl 1): S1-207-S1-271, 2002. ventricle. A retrospective review of 112 cases operated 19.Secer HI, Duz B, Izci Y, Tehli O, Solmaz I, Gonul E. upon 1970-1997. Neurosurg Rev 21:126-137, 1998. Tumors of the lateral ventricle: The factors that affected 6.Jeeves MA, Simpson DA, Gellen G. Functional the preference of the surgical approach in 46 patients. consequences in the transcallosal removal of Turkish Neurosurgery 2008, vol. 18, No. 4, 345-355. intraventricular tumors. J Neurol Neurosurg Psychiatry 20.Shen Ho Y, Plets C, Goffin J, Dom R: 42:134-142, 1979. of the lateral ventricle. Surg Neurol 7.Jelinek L, Simimiotopoulos JG, Parisi JE, Kanzer M. 33: 407-412, 1990.

Romanian Neurosurgery (2014) XXI 1: 61 - 73 73 DOI: 10.2478/romneu-2014-0006

21.Spencer DD, Collins WF, Sass KJ. Surgical 24.Tew JMJr, Lewis AL, Reichert KW. Management management of lateral intraventricular tumors. In: strategies and surgical techniques for deep-seated Shmidek HH, Sweet W, eds. Operative neurosurgical supratentorial arteriovenous malformations. techniques. Orlando: Grune αStratton, 1988:583. Neurosurgery 36:1065-1072, 1995. 22.Suchart W. Anterior transcallosal and transcortical 25.Timurkaynak E, Rhoton MD Jr, Barry M. approaches. In: Apuzzo MLJ, eds. Surgery of the Third Microsurgical anatomy and operative approaches to the Ventricle. Baltimore: Williams αWilkins, 1987, pp. 303- lateral ventricles. Neurosurgery 19: 685-723, 1986. 325. 26.Winston KR, Cavazzuti V, Arkins T: Absence of 23.Takafumi Nishizaki. Surgical Approaches for Lateral neurological and behavioral abnormalities after anterior Ventricular Trigone . In: Monleon D, eds. transcallosal operation for third ventricular lesions. Meningiomas – Management and Surgery. ISBN 978- Neurosurgery 4:386-393, 1979. 953-51-0175-8., 2012.