title: Retractorless surgery for third ventricle tumor resection through the transcallosal approach.
abstract: OBJECTIVE
  Resection of tumors of the third ventricle through the transcallosal-interforniceal approach presents a surgical challenge with potential serious postoperative neurological deficits and complications. Retraction injury of the deep brain tissue and veins is a possible reason. Here, we aimed to investigate the feasibility and value of retractorless surgery in third ventricle tumor resection.
  
  
  METHODS
  Since 2014, a total of 31 patients with third ventricle tumors were operated in our institution. All patients were operated using the transcallosal-interforniceal approach with a straight incision. The use of self-retaining retractor or constant retraction was not allowed. At the end of surgery, the opening of corpus callosum was sealed with fibrin glues. The degrees of tumor resection and postoperative neurological function deficits as well as complications were analyzed. The effect of retractorless surgery was evaluated according to the brain edema around the surgical approach on T2 imaging.
  
  
  RESULTS
  Thirty-one tumors were located in the anterior, middle, and posterior of the third ventricle. Total or gross total resection was achieved in 25 patients (80.6%). Postoperative neurological function deficits occurred in 4 patients (12.9%), and patients with mutism had a good recovery 3 weeks post-surgery. Retraction injuries around the surgical pathway were not obvious on T2 imaging. In addition, no subdural hygroma and subcutaneous fluid accumulation occurred.
  
  
  CONCLUSIONS
  The application of retractorless surgery in third ventricle tumors is feasible with enough exposure of tumors. This application could decrease the occurrence of postoperative neurological deficits and complications by avoiding the retraction injury on the deep brain structures.
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, China. Electronic address: wangxiangtim@gmail.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, China.
authors.forename: Yan-Hui
authors.initials: YH
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D003337:Corpus Callosum / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011184:Postoperative Period; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neurosurgical complications; Retraction injury; Retractorless surgery; Third ventricle tumors; Transcallosal approach