Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience.
BACKGROUND
Resection of an intraventricular mass can result in life-altering complications. Many advocate transcallosal rather than transcortical approaches to these lesions, citing differential postoperative seizure risk.


OBJECTIVE
To test the hypothesis that the complication rates and patient outcomes are no different between these ventricular approaches.


METHODS
The medical records of 127 patients (93 adults and 34 children) operated on for intraventricular lesions between 1996 and 2007 were retrospectively analyzed. Risk factors for specific postoperative complications and outcome were assessed by multivariate analysis.


RESULTS
The transcallosal (59%) or transcortical (41%) approach was used. Gross or nearly total resection was achieved in 87% of cases. The permanent neurological complication rate determined by a staff neurologist was 23.6%. Seizure attributable to surgery occurred after 8% of transcortical and 25% of transcallosal operations (P=.01). After controlling for a variety of factors, the transcallosal approach carried a 4.4-fold increased risk of seizure (95% confidence interval, 1.3-18.9). The operative approach was not a risk factor for any other postoperative complication. One year after surgery, 72% of patients had excellent functional outcome (Karnofsky Performance Score≥70 and Glasgow Outcome Score=5). High tumor grade and impaired preoperative Karnofsky Performance Score predicted poor outcome. More than 90% of patients operated on for symptomatic colloid cysts (n=34) had an excellent outcome.


CONCLUSIONS
Although the 2 traditional approaches to the ventricular system had similar major complication rates, the transcallosal approach was associated with significantly increased seizure risk. Accordingly, the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Brian D
BD
Milligan
Fredric B
FB
Meyer
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D017567:Karnofsky Performance Status; D020547:Lateral Ventricles / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009017:Morbidity; D009493:Neurosurgery / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D020542:Third Ventricle / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult