Pre-coronal, paramedian minicraniotomy: a minimal access approach for microsurgical, transcallosal, transforaminal removal of colloid cysts of the third ventricle.
OBJECTIVE
Microsurgical excision of colloid cysts of the third ventricle is accomplished along the transcallosal or the transfrontal routes. In the transcallosal approach, venous tributaries of the superior sagittal sinus can often act as an impediment to entry into the interhemispheric fissure for accessing the corpus callosum. We propose a paramedian minicraniotomy anterior to the coronal suture for removing colloid cysts via the transcallosal approach as veins are relatively rare in this area.


METHODS
A triangular minicraniotomy was designed with each side measuring 3 cm based on the midline in the pre-coronal area of the frontal bone on the right side. Nineteen cases of symptomatic colloid cysts of the third ventricle whose diagnoses were proven by CT and/or MRI were subjected to microsurgery in the period from June 2004 to May 2007. Following the minicraniotomy the cysts were removed utilizing the transcallosal transforaminal route.


RESULTS
Venous tributaries crossing the interhemispheric fissure were seen in 2 patients and these could be avoided to access the corpus callosum. Complete excision could be achieved in all cases. All patients had a good outcome although one patient had transient left lower limb weakness. The mean operating time was 163 minutes, while the mean duration of stay in the intensive care unit and hospitalization were 1.35 days and 3.73 days, respectively.


CONCLUSIONS
The pre-coronal, paramedian minicraniotomy is safe and effective for the total excision of colloid cysts of the third ventricle. As a minimal access approach, it needs only a short duration of postoperative hospitalized care.
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. dreaswer@gmail.com
H V
HV
Easwer
R N
RN
Bhattacharya
S
S
Nair
B R M
BR
Rao
G
G
Menon
M
M
Abraham
K K
KK
Kumar
D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002550:Cerebral Veins / Q000033:anatomy & histology / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002552:Cerebral Ventricles / Q000033:anatomy & histology / Q000601:surgery; D003102:Colloids / Q000737:chemistry; D003337:Corpus Callosum / Q000033:anatomy & histology / Q000601:surgery; D003392:Cranial Sinuses / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011859:Radiography; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D003102:Colloids