Abstract
Background. We have previously described the resection of hypothalamic hamartomas (HH) using
a transcallosal approach [Transcallosal resection of hypothalamic hamartomas, with
control of seizures, in children with gelastic epilepsy, Neurosurgery, 2001]. Since
then, we have refined the technique and now describe in detail an anterior transcallosal
transseptal interforniceal approach to the third ventricle as a variation of the standard
transcallosal interforniceal approach. The results of this series are presented to
demonstrate the safety and efficacy of this approach. Method. HH were resected via an anterior transcallosal, transseptal, interforniceal approach
to the third ventricle. This is a more anterior approach to the third ventricle with
a more acute trajectory than has been described previously. Results. This approach provided excellent access to the floor of the third ventricle with
minimal forniceal retraction and avoidance of dissection of the deep venous structures.
Transcallosal resection of HH was performed in 45 patients aged 2.9–33 years (mean
11.3 years). Morbidity was minimal, including transient hemiparesis in 3, ongoing
diabetes insipidus in 2, early short-term memory impairment in 16 (persistent in 6)
and one patient developed pneumonia postoperatively but recovered. Conclusion. The anterior transcallosal transseptal interforniceal technique is an effective
and relatively safe technique when used for the resection of HH. This operative approach
is applicable to other pathology in the third ventricle or hypothalamic region and
has advantages compared with the standard transcallosal approach to the third ventricle.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcallosal interforniceal approach.in: Apuzzo M.L.J. Surgery of the Third Ventricle. second edn. Williams and Wilkins, Baltimore1998: 421-452
- The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma.J. Neurosurg. 1999; 91: 212-220
- Removal of craniopharyngioma by a unilateral interhemispheric trans-lamina terminalis approach: operative procedures and postoperative management.in: Samii M. Surgery In and Around the Brain Stem and the Third Ventricle. Springer, New York1986: 389-395
- Gelastic seizures, precocious puberty, and hypothalamic hamartoma.Neurology. 1985; 35: 1180-1183
- Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment.Neurology. 1993; 43: 747-750
- Pathological correlates of amnesia and the anatomical basis of memory.in: Apuzzo M.L.J. Surgery of the Third Ventricle. Williams and Wilkins, Baltimore1998: 187-204
- Disconnecting surgical treatment of hypothalamic hamartoma in children and adults with refractory epilepsy and proposal of a new classification.Neurol. Med. Chir. (Tokyo). 2003; 43: 61-68
- Hypothalamic gliomas.Adv. Tech. Stds. Neurosurg. 1999; 25: 161-194
- The use of stereotactic radiosurgery to treat intractable childhood partial epilepsy.Epilepsia. 2002; 43: 292-300
- Considerations on transforaminal entr.in: Apuzzo M.L.J. Surgery of the Third Ventricle. Williams and Wilkins, Baltimore1998: 391-419
- The endocrinology of transcallosal hypothalamic hamartoma resection for intractable epilepsy.Epileptic disorders. 2003; 5: 239-247
- The evolution and postoperative resolution of symptomatic generalised epilepsy in hypothalamic hamartomas.Neurology. 2003; 60: 762-767
- MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases.Am. J. Neuroradiol. 2004; 25: 450-462
- Endoscopy for intraventricular lesions.in: King W.A. Frazee J. DeSalles A. Endoscopy of the Central and Peripheral Nervous System. Thieme, New York1997: 68-77
- Manual of Endoscopic Procedures in Neurosurgery.Uitgeverij Machaon, Nijmegen1995
- Transcallosal resection of hypothalamic hamartomas in patients with intractable epilepsy.Epileptic Disorders. 2003; 5: 257-265
- The role of the hypothalamic hamartoma in the genesis of gelastic and dacrystic seizures.in: Tuxhorn I. Hothausen H. Boenigk H. Paediatric Epilepsy Syndromes and Their Surgical Treatment. John Libbey, London1997: 447-461
- Infratentorial supracerebellar approach to the colloid cysts of the third ventricle.Neurosurgery. 2001; 49: 1116-1122
- Intrinsic epileptogenesis of hypothalamic hamartomas in gelastic epilepsy.Ann. Neurol. 1997; 42: 60-67
- The subchoroidal trans-velum interpositum approach.in: Apuzzo M.L.J. Surgery of the Third Ventricle. Williams and Wilkins, Baltimore1998: 453-469
- Craniopharyngiomas of the third ventricle: trans-lamina terminalis approach.Neurosurgery. 2000; 47: 857-863
- Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy.Neurology. 2002; 58: 1338-1347
- Two approaches to the anterior third ventricle. I. Via the velum interpositum. II. Via the lamina terminals and sphenoid sinus.in: Samii M. Surgery In and Around the Brain Stem and the Third Ventricle. Springer, New York1986: 329-333
- Gamma knife surgery for epilepsy related to hypothalamic hamartomas.Neurosurgery. 2000; 47: 1343-1351
- Transcallosal resection of hypothalamic hamartomas, with control of seizures, in children with gelastic epilepsy.Neurosurgery. 2001; 48: 108-118
- Removal of tumors in the third ventricle.in: Wilson C.B. Neurosurgical Procedures: Personal Approaches to Classic Operations. Williams and Wilkins, Baltimore1992: 52-62
- Interhemispheric trans-lamina terminalis approach by bifrontal craniotomy to tumor of the anterior part of third ventricle.in: Samii M. Surgery In and Around the Brain Stem and the Third Ventricle. Springer, New York1986: 334-338
- Hemispheric disconnection: callosotomy and hemispherotomy.Adv. Tech. Stand Neurosurg. 2000; 26: 25-78
- Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application.Neurosurgery. 1998; 42: 1205-1217
- A randomized, controlled trial of surgery for temporal-lobe epilepsy.N. Engl. J. Med. 2001; 345: 311-318
- Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results.Neurosurgery. 2000; 46: 879-890
- Intraventricular tumours.in: Microneurosurgery. Microsurgery of CNS Tumors. vol. IVB. Thieme, New York1996: 313-338
Article info
Publication history
Accepted:
March 10,
2004
Received:
February 13,
2004
Identification
Copyright
© 2004 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
