Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: A single-institution experience

Brian D. Milligan, Fredric B. Meyer

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

BACKGROUND: Resection of an intraventricular mass can result in life-altering complications. Many advocate transcallosal rather than transcortical approaches to these lesions, citing differential postoperative seizure risk. OBJECTIVE: To test the hypothesis that the complication rates and patient outcomes are no different between these ventricular approaches. METHODS: The medical records of 127 patients (93 adults and 34 children) operated on for intraventricular lesions between 1996 and 2007 were retrospectively analyzed. Risk factors for specific postoperative complications and outcome were assessed by multivariate analysis. RESULTS: The transcallosal (59%) or transcortical (41%) approach was used. Gross or nearly total resection was achieved in 87% of cases. The permanent neurological complication rate determined by a staff neurologist was 23.6%. Seizure attributable to surgery occurred after 8% of transcortical and 25% of transcallosal operations (P = .01). After controlling for a variety of factors, the transcallosal approach carried a 4.4-fold increased risk of seizure (95% confidence interval, 1.3-18.9). The operative approach was not a risk factor for any other postoperative complication. One year after surgery, 72% of patients had excellent functional outcome (Karnofsky Performance Score <70 and Glasgow Outcome Score = 5). High tumor grade and impaired preoperative Karnofsky Performance Score predicted poor outcome. More than 90% of patients operated on for symptomatic colloid cysts (n = 34) had an excellent outcome. CONCLUSION: Although the 2 traditional approaches to the ventricular system had similar major complication rates, the transcallosal approach was associated with significantly increased seizure risk. Accordingly, the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures.

Original languageEnglish (US)
Pages (from-to)1483-1496
Number of pages14
JournalNeurosurgery
Volume67
Issue number6
DOIs
StatePublished - Dec 2010

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Third Ventricle
Lateral Ventricles
Seizures
Morbidity
Colloid Cysts
Medical Records
Neoplasms
Multivariate Analysis
Confidence Intervals

Keywords

  • Intraventricular neoplasm
  • Neurosurgery
  • Patient outcomes
  • Postoperative complications
  • Seizures

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles : A single-institution experience. / Milligan, Brian D.; Meyer, Fredric B.

In: Neurosurgery, Vol. 67, No. 6, 12.2010, p. 1483-1496.

Research output: Contribution to journalArticle

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AB - BACKGROUND: Resection of an intraventricular mass can result in life-altering complications. Many advocate transcallosal rather than transcortical approaches to these lesions, citing differential postoperative seizure risk. OBJECTIVE: To test the hypothesis that the complication rates and patient outcomes are no different between these ventricular approaches. METHODS: The medical records of 127 patients (93 adults and 34 children) operated on for intraventricular lesions between 1996 and 2007 were retrospectively analyzed. Risk factors for specific postoperative complications and outcome were assessed by multivariate analysis. RESULTS: The transcallosal (59%) or transcortical (41%) approach was used. Gross or nearly total resection was achieved in 87% of cases. The permanent neurological complication rate determined by a staff neurologist was 23.6%. Seizure attributable to surgery occurred after 8% of transcortical and 25% of transcallosal operations (P = .01). After controlling for a variety of factors, the transcallosal approach carried a 4.4-fold increased risk of seizure (95% confidence interval, 1.3-18.9). The operative approach was not a risk factor for any other postoperative complication. One year after surgery, 72% of patients had excellent functional outcome (Karnofsky Performance Score <70 and Glasgow Outcome Score = 5). High tumor grade and impaired preoperative Karnofsky Performance Score predicted poor outcome. More than 90% of patients operated on for symptomatic colloid cysts (n = 34) had an excellent outcome. CONCLUSION: Although the 2 traditional approaches to the ventricular system had similar major complication rates, the transcallosal approach was associated with significantly increased seizure risk. Accordingly, the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures.

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