title: Trans-lamina terminalis approach for third ventricle and suprasellar tumours.
abstract: BACKGROUND
  The trans-lamina terminalis (TLT) approach to the suprasellar region and third ventricle is complex, with risks of visual and hormonal deficits. However, the postoperative deficits might not be directly related to opening of the lamina terminalis but to the close relationship of tumours with vital neural and vascular structures. The analysis of results using this approach was the objective of this study.
  
  
  METHODS
  The TLT approach was used in 29 patients (18 craniopharyngiomas, 5 astrocytomas, 5 germinomas and 1 ganglioglioma). The extent of tumour removal, mortality and morbidity (especially visual or hormonal deficits) were studied.
  
  
  RESULTS
  Complete tumour removal was achieved in 15 patients, subtotal extensive removal (more than 90%) in 9 cases and partial removal in 5 cases. Panhypopituitarism developed in 22 patients. Total tumour removal was associated with the development of endocrinological disturbances. There was worsening or the onset of new visual field defects in 4 cases. Postoperative endocrine and visual deficits were in the range generally described regarding surgery for tumours in this region.
  
  
  CONCLUSIONS
  The TLT approach allows for extensive removal of third ventricle and suprasellar tumours, without increased risks of visual and hormonal deficits, compared to those described regarding surgery for lesions in this region.
authors.affiliation: Neurosurgery Department, Hospital de São João, Porto, Portugal. pedrodossantossilva@gmail.com
authors.forename: Pedro Santos
authors.initials: PS
authors.lastname: Silva
authors.forename: António
authors.initials: A
authors.lastname: Cerejo
authors.forename: Patrícia
authors.initials: P
authors.lastname: Polónia
authors.forename: Josué
authors.initials: J
authors.lastname: Pereira
authors.forename: Rui
authors.initials: R
authors.lastname: Vaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000453:epidemiology / Q000209:etiology; D007031:Hypothalamus / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012658:Sella Turcica / Q000601:surgery; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology; D014794:Visual Fields; D055815:Young Adult
keywords: Lamina terminalis; Suprasellar tumour; Third ventricle tumour; Trans-lamina terminalis