Transcortical or transcallosal approach to ventricle-associated lesions: a clinical study on the prognostic role of surgical approach.
Most entities in and around the anterior two-thirds of the supratentorial ventricles can be reached via transcortical or transcallosal approach. This study examined the effect of surgical approach on the postoperative neurological outcome. Thirty-eight patients with intra- and periventricular supratentorial lesions were operated on by either frontal transcortical or anterior transcallosal approach. Postoperative diencephalic damage occurred in 22% of patients in the transcortical group and in 36% in the transcallosal group; transient mutism was virtually equivalent in the two groups. Postoperative epilepsy (26%) and subdural fluid collections (30%) occurred only in the transcortical group. The incidence of postoperative hemiparesis was higher in the transcallosal group. There was a high correlation between postoperative Glasgow Outcome Score of 5 and preoperative severity of neurological disease but no correlation between postoperative Glasgow Outcome Score of 5 and location of the lesion or between postoperative clinical course and surgical approach. Surgical outcome of ventricle-associated lesions depends mainly on the severity of preoperative symptoms and not on surgical approach. Additionally, the incidence of postoperative seizures and subdural fluid collections after transcortical surgery is high.
Asgari
Siamak
S
Department of Neurosurgery, University Hospital of Essen, Hufelandstrasse 55, 45147 Essen, Germany. siamek.asgari@uni-essen.de
Engelhorn
Tobias
T
Brondics
Anja
A
Sandalcioglu
Ibrahim Erol
IE
Stolke
Dietmar
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index