Balloon-Assisted Corpus Callosotomy. Reducing the Impact of Transcallosal Approaches.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
received:
10
11
2021
accepted:
12
09
2022
pubmed:
27
1
2023
medline:
18
2
2023
entrez:
26
1
2023
Statut:
ppublish
Résumé
The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes. To open an operative window in the corpus callosum through separation rather than disconnection of the white matter fibers. In 7 patients undergoing the interhemispheric transcallosal approach for intraventricular lesions, lying around or below the foramen of Monro, a stoma was created within the corpus callosum by using a 4F Fogarty catheter. The series included 3 colloid of the third ventricle, 2 thalamic cavernomas, 1 subependymoma, and 1 ependymoma of the foramen of Monro. We illustrate the technique and the clinico-radiological outcome, focusing on the size of callosotomy as seen on postoperative MRI. The balloon-assisted corpus callosotomy provided a circular, smooth-walled access to the ventricular chambers, which allowed uncomplicated removal of the lesions. On postoperative MRI, the size of the callosotomy shrinked compared with surgery (2.8-6.4 mm at follow-up vs 6-9 mm as measured intraoperatively). No signs of disconnection syndrome or new permanent deficits were observed in this series. The balloon-assisted technique produces a small callosotomy, without clinical consequences, showing a self-closing trend on postoperative MRI. This technique is a rewarding tool to reduce the impact of callosotomy while keeping the advantages of microsurgical interhemispheric approaches.
Sections du résumé
BACKGROUND
The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes.
OBJECTIVE
To open an operative window in the corpus callosum through separation rather than disconnection of the white matter fibers.
METHODS
In 7 patients undergoing the interhemispheric transcallosal approach for intraventricular lesions, lying around or below the foramen of Monro, a stoma was created within the corpus callosum by using a 4F Fogarty catheter. The series included 3 colloid of the third ventricle, 2 thalamic cavernomas, 1 subependymoma, and 1 ependymoma of the foramen of Monro. We illustrate the technique and the clinico-radiological outcome, focusing on the size of callosotomy as seen on postoperative MRI.
RESULTS
The balloon-assisted corpus callosotomy provided a circular, smooth-walled access to the ventricular chambers, which allowed uncomplicated removal of the lesions. On postoperative MRI, the size of the callosotomy shrinked compared with surgery (2.8-6.4 mm at follow-up vs 6-9 mm as measured intraoperatively). No signs of disconnection syndrome or new permanent deficits were observed in this series.
CONCLUSION
The balloon-assisted technique produces a small callosotomy, without clinical consequences, showing a self-closing trend on postoperative MRI. This technique is a rewarding tool to reduce the impact of callosotomy while keeping the advantages of microsurgical interhemispheric approaches.
Identifiants
pubmed: 36701680
doi: 10.1227/ons.0000000000000514
pii: 01787389-202303000-00020
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e155-e159Informations de copyright
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
Références
Bellotti C, Pappadà G, Sani R, Oliveri G, Stangalino C. The transcallosal approach for lesions affecting the lateral and third ventricles. Surgical considerations and results in a series of 42 cases. Acta Neurochir (Wien). 1991;111(3-4):103-107.
Jeeves MA, Simpson DA, Geffen G. Functional consequences of the transcallosal removal of intraventricular tumours. J Neurol Neurosurg Psychiatry. 1979;42(2):134-142.
Peltier J, Roussel M, Gerard Y, et al. Functional consequences of a section of the anterior part of the body of the corpus callosum: evidence from an interhemispheric transcallosal approach. J Neurol. 2012;259(9):1860-1867.
Sussman NM, Gur RC, Gur RE, O’Connor MJ. Mutism as a consequence of callosotomy. J Neurosurg. 1983;59(3):514-519.
Sauerwein HC, Lassonde M. Cognitive and sensori-motor functioning in the absence of the corpus callosum: neuropsychological studies in callosal agenesis and callosotomized patients. Behav Brain Res. 1994;64(1-2):229-240.
Caillé S, Sauerwein HC, Schiavetto A, Villemure J-G, Lassonde M. Sensory and motor interhemispheric integration after section of different portions of the anterior corpus callosum in nonepileptic patients. Neurosurgery 2005;57(1):50-59; discussion 50-59.
Symss NP, Ramamurthi R, Kapu R, et al. Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: an analysis of 80 cases. Asian J Neurosurg. 2014;9(2):51-57.
Liu W, Liu R, Ma Z, Li C. Transcallosal Anterior interforniceal approach for removal of superior midbrain cavernous malformations in children: a retrospective series of 10 cases in a single center. World Neurosurg. 2018;118:e188-e194.
Sampath R, Vannemreddy P, Nanda A. Microsurgical excision of colloid cyst with favorable cognitive outcomes and short operative time and hospital stay: operative techniques and analyses of outcomes with review of previous studies. Neurosurgery. 2010;66(2):368-374; discussion 374-375.
Dandy WE. Benign tumors in the third ventricle of the brain: diagnosis and treatment. In: Benign Tumors in the Third Ventricle of the Brain: Diagnosis and Treatment. 1933:171. pesquisa.bvsalud.org
Esposito V, di Russo P, Del Maestro M, et al. The interhemispheric transgenual approach for microsurgical removal of third ventricle colloid cysts. Technical note. World Neurosurg. 2020;142:197-205.
Hernesniemi J, Romani R, Dashti R, et al. Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach–experience of 134 patients. Surg Neurol. 2008;69(5):447-453; discussion 453-456.
Cohen-Gadol AA. Interhemispheric transcallosal route for resection of anterior third ventricular lesions. Neurosurg Focus. 2013;34(1 suppl):Video 7.
Liu JK. Interhemispheric transcallosal approach for resection of intraventricular central neurocytoma. Neurosurg Focus. 2013;34(1 suppl):Video 3.
Milligan BD, Meyer FB. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery. 2010;67(6):1483-1496; discussion 1496.
Cohen-Gadol AA. Minitubular transcortical microsurgical approach for gross total resection of third ventricular colloid cysts: technique and assessment. World Neurosurg. 2013;79(1):207.e7-207.e10.
Serra C, Türe H, Yaltırık CK, Harput MV, Türe U. Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series. J Neurosurg. 2020;135(2):458-468.
Friedman MA, Meyers CA, Sawaya R. Neuropsychological effects of third ventricle tumor surgery. Neurosurgery. 2008;62(6 suppl 3):1093-1100.
Mazza M, Di Rienzo A, Costagliola C, et al. The interhemispheric transcallosal-transversal approach to the lesions of the anterior and middle third ventricle: surgical validity and neuropsychological evaluation of the outcome. Brain Cogn. 2004;55(3):525-534.
Gökalp HZ, Yüceer N, Arasil E, Erdogan A, Dincer C, Baskaya M. Colloid cyst of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal/transventricular (3 cases) approaches. Acta Neurochir. 1996;138(1):45-49.
Hütter BO, Spetzger U, Bertalanffy H, Gilsbach JM. Cognition and quality of life in patients after transcallosal microsurgery for midline tumors. J Neurosurg Sci. 1997;41(1):123-129.
Tsivilis D, Vann SD, Denby C, et al. A disproportionate role for the fornix and mammillary bodies in recall versus recognition memory. Nat Neurosci. 2008;11(7):834-842.
Koivisto AM, Kurki MI, Alafuzoff I, et al. High risk of dementia in ventricular enlargement with normal pressure hydrocephalus related symptoms. J Alzheimers Dis. 2016;52(2):497-507.
Aggleton JP, McMackin D, Carpenter K, et al. Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix. Brain. 2000;123(pt 4):800-815.
Shucart WA, Stein BM. Transcallosal approach to the anterior ventricular system. Neurosurgery. 1978;3(3):339-343.
Serra C, Türe U. The extreme anterior interhemispheric transcallosal approach for pure aqueduct tumors: surgical technique and case series. Neurosurg Rev. 2022;45(1):499-505.
Shapiro S, Rodgers R, Shah M, Fulkerson D, Campbell RL. Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle: clinical article. J Neurosurg. 2009;110(1):112-115.
Perneczky A, Reisch R. Keyhole Approaches in Neurosurgery. Volume 1: Concepts and Surgical Technique. Springer Wien; 2008. ISBN: 978-3-211-83885-3. 644 Pages.