Microsurgical strategies of lateral ventricle gliomas

Objective To enhance the therapeutic effects through ameliorating the microsurgical strategies and methods of lateral ventricle gliomas.Methods The clinical manifestations,diagnoses and microsurgical approaches of 23 patients,who were treated in our hospital during January 2000 and June 2007 and pathologically diagnosed as lateral ventricle gliomas,were retrospectively analyzed.Clinical data included 15 cases of raised intracranial pressure with the primary symptom of headache,4 cases of progressive unilateral limb muscle strength decline,5 cases of memory descent and 2 cases of epilepsy.The optimal surgical approaches and comprehensive therapeutic strategies were selected according to the imaging features and pathological properties of tumors. Resection was performed via the anterior transcallosal approach in 6 cases,the transcortical approach in 5 cases,the combined interhemispheric transcallosal and transcortical approach in 4 patients to remove tumors in the anterior horn and anterior body of the lateral ventricle,the transparietal cortical approach in 7 patients to remove tumors in the trigone or posterior body of the lateral ventricle,and the transoccipital cortical approach in 1 case.The navigation orientation was used in 6 cases and supervision by type-B ultrasonic,in 4 cases.Patients with tumors above gradeⅡ,confirmed pathologically after resection, underwent chemotherapy(Vumon+lomustine/methy1-CCNU)and radiotherapy which was designated individually according to the pathological grades and scope of gliomas.The follow-up study was conducted by telephone,e-mail or outpatient department visits etc.Results A total of 23 of the 79 cases undergoing microsurgical treatment for their lateral ventricle tumors were pathologically confirmed as cerebral gliomas after resection, including astrocytomas in 11 cases,oligodendrogliomas in 6 cases, central neurocytomas in 4 cases and ependymomas in 2 cases.Tumors in the anterior horn and body of the lateral ventricle were found in 15 cases and that in the trigone and posterior horn were found in 8 cases.Total resection was realized in 15 cases;subtotal resection in 6 cases and partial resection in 2 cases.Postoperative clinical symptoms were alleviated in 18 cases,aggravated in 2 cases and unchanged in 3 cases and 1 case died of the complicating pulmonary infection.The follow-up indicated that 17 cases survived over 1 year and 6 cases died within the postoperative 1 year.Conclusion The lateral ventricle gliomas can be treated through careful selection of surgical approaches after the anatomic site of tumors in the lateral ventricle,adjoining relationships,blood supply and the existence of hydrocephalus have been well understood,to reduce disability rate and achieve favorable efficacies.Navigation assistance or real-time supervision by type-B ultrasonic,in combination with microsurgery,shall help to enhance the resection rate of tumors and assisted by appropriate therapeutic strategies,prognosis of the later ventricle gliomas can be ameliorated.