Trigonal and peritrigonal lesions of the lateral v

Authors: Fernando Ruiz Juretschke Erdem Güresir Gerhard Marquardt Joachim Berkefeld Steffen Rosahl Joachim Klisch Andreas Raabe Volker Seifert Rüdiger Gerlach

Publish Date: 2010/06/22

Volume: 33, Issue: 4, Pages: 457-464

PDF Link

Abstract

The aim of this study is to review the results and clinical outcome of patients with surgically treated lesions within the trigone of the lateral ventricle This is a retrospective case series of 20 eight male 12 female patients with lesions of the trigone of the lateral ventricle operated between 1998 and 2008 All lesions were removed via the transcortical temporal and transcortical parietal route Surgical complications and outcome were assessed using the modified Rankin Scale mRS There were four children and 16 adults with a mean age of 42 ± 22 years min = 1 max = 74 Eight 40 lesions grew within the trigone of the dominant hemisphere In 17 cases the lesion was purely intraventricular and in three cases a slight paraventricular extension was seen The mean size was 45 cm of maximal diameter Surgical removal was achieved via the transcortical parietal route in 13 cases 65 and the transcortical temporal route in seven cases 35 In all cases complete resection was possible According to the mRS 13 patients improved five remained the same and two were lost to followup One patient had an increased visual field deficit postoperatively and new hemiparesis and aphasia but returned to the preoperative level within a few weeks In one patient an acute myocardial infarction occurred due to previous cardiac stent placement and instent stenosis Even large trigonal lesions can be resected with low morbidity using a transcortical approach depending on the peritrigonal extension of the tumorLesions in the trigonal region require a profound anatomical knowledge to decide the optimal surgical approach to avoid neurological sequelae All patients were either operated on a transcortical temporal or transcortical parietal approach postoperative neurological deficits were low The series of 20 patients spans a long period of 10 years so that the influence of modern navigation techniques cannot be estimated It will be interesting to see in the future on whether the application of sophisticated navigation techniques allowing the identification of eloquent cortical and subcortical brain structures such as the speech areas and pathways as well as the optic radiation will further influence the decision making on the optimal approach and at all be able to further improve the good neurological outcomeThis is a carefully elaborated series of tumors located in the trigonal and peritrigonal region of the lateral ventricle which have been operated by two different approaches Those less frequent lesions are associated with potential risks to harm the visual tract the precentral gyrus the thalamus the vascular supply of the choroidal arteries and the deep venous system the speech and angular region in the dominant hemisphere and the corpus callosum depending on the approach The authors present their good results by either using the transcortical temporal or transcortical parietal route respectively In addition alternative routes are described and discussed leading to one important message of the paper Those deepseated and frequently large lesions should not be underestimated Of course the presented two routes are not the solution for every situation and the decision will be affected also by personal experience but in any case an individual thoroughly tailored approach is mandatory to avoid the above mentioned sequelae This is important to remember just for those lesions which do not occur on a daily basis

Keywords: