title: Craniopharyngiomas of the third ventricle: trans-lamina terminalis approach.
abstract: OBJECTIVE
  Craniopharyngiomas usually grow on the cisternal surface of the hypothalamic region; these tumors can also grow from the infundibulum or tuber cinereum on the floor of the third ventricle, developing exclusively into the third ventricle. The aim of the present work was to establish the usefulness of the pterional trans-lamina terminalis approach for the removal of these tumors.
  
  
  METHODS
  Eight patients who were surgically treated for craniopharyngiomas located exclusively within the third ventricle were considered. The initial symptoms were acute hydrocephalus in two cases, psychological disturbances in two, amenorrhea in two, headaches in one, and hypopituitarism in one. The diagnoses were established, in all cases except one, with magnetic resonance imaging. In all cases, the tumor completely filled the third ventricle.
  
  
  RESULTS
  Total removal of the lesion was achieved in seven cases. One patient underwent partial removal. In the immediate postoperative period, no major complications were observed. Five patients required replacement hormonal therapy. All patients returned to a normal life. Many months after surgery, two patients exhibited psychological disturbances and died, the first because of voluntary withdrawal of replacement therapy (12 mo after surgery) and the second because of a severe imbalance in body fluids and electrolytes, with a subsequent hyperosmolar coma (27 mo after surgery). Only one patient who underwent initial total removal experienced a small recurrence of the lesion (30 mo after surgery); after 3 years, the lesion exhibited unchanged size.
  
  
  CONCLUSIONS
  In our experience, the trans-lamina terminalis approach is a valid choice for the removal of purely intraventricular craniopharyngiomas. These tumors can be removed without significant sequelae related to the surgical approach. The proximity to the hypothalamus requires accurate neuroendocrine and electrolyte control in the postoperative period, in some cases even years after surgery.
authors.affiliation: Institute of Neurosurgery, Università Cattolica, Rome, Italy. iclnc@rm.unicatt.it
authors.forename: G
authors.initials: G
authors.lastname: Maira
authors.forename: C
authors.initials: C
authors.lastname: Anile
authors.forename: C
authors.initials: C
authors.lastname: Colosimo
authors.forename: D
authors.initials: D
authors.lastname: Cabezas
mesh_terms: D000293:Adolescent; D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003397:Craniopharyngioma / Q000175:diagnosis / Q000601:surgery*; D004573:Electrolytes / Q000378:metabolism; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D011184:Postoperative Period; D020542:Third Ventricle / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D004573:Electrolytes