Open Approaches to Intraventricular Tumors, Colloid Cysts, and the Subcortical Space

Abstract

Intraventricular tumors account for less than 2% of all intracranial tumors but are more common among children and adolescents. Colloid cysts are the most prevalent tumor of the third ventricle causing obstruction of the foramen of Monro, despite accounting for less than 2% of primary brain tumors overall. Resection of symptomatic and sometimes even incidental lesions is recommended due to potential for serious complications including sudden death. In current practice, the transcortical and transcallosal approaches are the two most heavily favored procedures for debulking the cyst and removing all cyst wall attachments, but preferences vary by the institution and individual surgeon. For tumors located in the lateral ventricles and fourth ventricles, several approaches may be utilized with the ultimate consideration being the preservation of eloquent brain regions. Techniques for removal of these lesions are reviewed with attention paid to complication profiles of different approaches in relation to ventricular anatomy. The relative advantages and limitations of endoscopic versus microsurgical approaches are discussed in the context of specific clinical scenarios. Open approaches to the subcortical spaces are briefly discussed as well, with attention to the benefits and risks of transgyral and transsulcal approaches.