P18.03 Third ventricle tumors: surgical treatment

Abstract

BACKGROUND: A variety of tumors can occur in the third ventricle. Despite the fact that some of these tumors are aggressive high grade lesions, most of them are histologically benign and potenially curable after surgical resection. Considering the slow growth of this tumors, for a long time, this lesions remain clinically asymptomatic, until they reach significant size, which makes surgical removal technically difficult. The aim of the current study was to identify patterns of results of surgical treatment of patients with third ventricle tumors, depending on the lesion location and its degree of differentiation. MATERIAL AND METHODS: A retrospective analysis of 45 consecutive surgical interventions on third ventricle tumors that were treated at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology in the period from January 2006 to January 2016. Localisation of tumors was as follows: pure third ventricle tumors-17 (38%), other regions tumors extension with involvment of the third ventricle-28 (62%). Tumor removal was performed in 41 cases, in other 4 cases ventriculo-peritoneal shunting was the only procedure. We used the following surgical approaches: transcallosal (17)-tumors of the anterior third of the third ventricle, pterional (14) and two-staged transcallosal-pterional approach (7)-sellar-parasellar region tumors with extension to third ventricle, subfrontal (1), supracerebellar infratentorial (1), interhemispheric transoccipital (1). Histological structure of the tumors: craniopharingioma-13 (33%), astrocytoma-9 (23%), colloid cyst-6 (16%), pituitary adenoma-4 (11%), ependymoma-2 (5%), choroid plexus papilloma-1 (2%), teratoma-1 (2%), central neurocytoma-1 (2%), chordoid glioma of the third ventricle-1 (2%) oligodendroglioma-1 (2%), pineoblastoma-1 (2%). The degree of tumors differentiaton: grade I-II-34 (83%), grade III-IV-7 (17%). RESULTS: According to the data the most frequent histological type among pure third ventricle tumors-colloid cyst (30%), among tumors with extension to the third ventricle-craniopharingioma (46%). The total tumor removal was achieved in 18 patients, of whom in 95% the degree of tumor differentiation was grade I-II. Postoperative mortality was 7%, of which 2 (80%)-with the grade III-IV differentiation. The results of treatment were assessed according to Karnofsky scale: more than 60 points-89% patients. CONCLUSIONS: Acceptable results of surgical treatment third ventricle tumors are in direct dependence from the tumor histological structure. The most unfavorable factor is low degree of tumor differentiation.