Minimally Invasive Parafascicular Surgical Approach for the Management of a Pediatric Third Ventricular Ependymoma: Case Report and Review of Literature.

Autor: Chakravarthi SS; Neuroanatomy Laboratory, Aurora Research Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA., Lyons L; Department of Clinical Neurosciences (Division of Neurosurgery), Spectrum Health, Grand Rapids, Michigan, USA., Bercu M; Department of Clinical Neurosciences (Division of Neurosurgery), Spectrum Health, Grand Rapids, Michigan, USA., Singer JA; Department of Clinical Neurosciences (Division of Neurosurgery), Spectrum Health, Grand Rapids, Michigan, USA. Electronic address: jasingermd@me.com.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2020 Sep; Vol. 141, pp. 311-317. Date of Electronic Publication: 2020 May 05.
DOI: 10.1016/j.wneu.2020.04.201
Abstrakt: Background: Minimally invasive parafascicular surgery (MIPS) has evolved into a safe alternative to access deep-seated subcortical and intraventricular pathologies. We present a case of a port-mediated resection of a pediatric third ventricular tumor.
Case Description: The patient is a 7-year-old boy who presented with worsening headache, nausea, vomiting, dizziness, unsteady gait, photophobia, and blind spots with positional changes. Magnetic resonance imaging (MRI) scan revealed a large isointense mass, with areas of hyperintensities suggestive of intratumoral hemorrhage, centered in the posterior segment of the third ventricle with extension into the aqueduct of Sylvius. The superior frontal sulcus was used as an access corridor for the port to the frontal horn of the lateral ventricle en route to the third ventricle. Intraoperative visualization was aided with a 3-dimensional exoscopic system. After cannulation, the tumor was seen within the foramen of Monro and tethered to the thalamostriate vein. The tumor was removed completely, with the exception of small residual attached to the thalamostriate vein, which was left intentionally. A flexible endoscope was placed through the port to verify the absence of residual along the superior wall of the third ventricle. Intraoperative MRI scan confirmed presence of residual, along with normal postoperative changes, including pneumocephalus. Postoperative MRI scan revealed cortical recovery along the sulcal path and resolution of ventriculomegaly.
Conclusions: The patient improved from baseline, with no remaining visual deficits, headaches, or balance issues. Pathology reported a World Health Organization grade II tanycytic ependymoma. To our knowledge, few cases have reported the utilization of port-based MIPS in pediatric patients.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: