title: Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle.
abstract: OBJECTIVE
  We report our experience with anterior interhemispheric approach for tumors in and around the anterior third ventricle, including surgical technique, instrumentation, pre- and postoperative hormonal disturbances, and resection rate.
  
  
  METHODS
  One hundred patients with 46 craniopharyngiomas, 12 hypothalamic gliomas, 12 meningiomas, 6 hypothalamic hamartomas, and 24 other lesions were operated on using an anterior interhemispheric approach with or without opening of the lamina terminalis. This surgical approach involves no frontal sinus opening; a narrow (approximately 15-20 mm in width) access between the bridging veins, which is sufficient to remove the tumor totally; and sparing of the anterior communicating artery. Specially designed long bipolar forceps and scissors are necessary for this approach, and concomitant use of angled instruments (endoscope, aspirator, and microforceps) is required frequently. The postsurgical follow-up period varied from 4 months to 18 years.
  
  
  RESULTS
  Total removal of the neoplasm was accomplished in 37 of 46 patients with craniopharyngiomas (80.4%), whereas subtotal resection was performed in hypothalamic gliomas. No significant differences in pre- and postoperative hormonal disturbances were observed in 37 craniopharyngiomas and 10 hypothalamic gliomas. There was no operative mortality. Visual acuity was preserved or improved in 68 of 75 patients assessed. The Karnofsky Performance Scale score did not deteriorate in 72 of 75 patients tested.
  
  
  CONCLUSIONS
  The minimally invasive anterior interhemispheric approach, with or without opening of the lamina terminalis, is useful for removal of tumors in and around the anterior third ventricle, such as craniopharyngiomas and hypothalamic gliomas.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. thori@moriyamaikai.or.jp
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.forename: Kosaku
authors.initials: K
authors.lastname: Amano
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Aihara
authors.forename: Masami
authors.initials: M
authors.lastname: Ono
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Miki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D054022:Cerebrum / Q000033:anatomy & histology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery; D006222:Hamartoma / Q000473:pathology / Q000601:surgery; D006801:Humans; D007031:Hypothalamus / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013525:Surgical Instruments / Q000592:standards; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult