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ORIGINAL ARTICLE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1417--1426

Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region: Review of Surgical Results

Narayanam A Sai Kiran1, Kanneganti Vidyasagar1, Rakshith Srinivasa2, Laxminadh Sivaraju1, Vivek Raj1, Sunil V Furtado2, Sumit Thakar1, Saritha Aryan1, Dilip Mohan1, Alangar S Hegde1 
1 Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
2 Department of Neurosurgery, MS Ramaiah Medical College and Hospital, MS Ramaiah Nagar, Mathikere, Bengaluru, Karnataka, India

Correspondence Address:
Kanneganti Vidyasagar
Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru - 560 066, Karnataka
India

Background: Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV). Objective: To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV. Materials And Methods: Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011–May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots. Results: Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions. Conclusion: Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.


How to cite this article:
Sai Kiran NA, Vidyasagar K, Srinivasa R, Sivaraju L, Raj V, Furtado SV, Thakar S, Aryan S, Mohan D, Hegde AS. Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region: Review of Surgical Results.Neurol India 2022;70:1417-1426


How to cite this URL:
Sai Kiran NA, Vidyasagar K, Srinivasa R, Sivaraju L, Raj V, Furtado SV, Thakar S, Aryan S, Mohan D, Hegde AS. Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region: Review of Surgical Results. Neurol India [serial online] 2022 [cited 2022 Nov 30 ];70:1417-1426
Available from: https://www.neurologyindia.com/article.asp?issn=0028-3886;year=2022;volume=70;issue=4;spage=1417;epage=1426;aulast=Sai;type=0