Surgical treatment of intraventricular tumors

In the last 11 years we operated on 20 patients (1.03% of all operated brain tumors) with lateral ventricular masses. Anamnesis lasted from 6 months in the case of epileptic seizures to 6 years when headache was the main symptom of disease only. Tumor was located in the anterior cornu and pars centralis in 15, in the trigonum of lateral ventricle in 2, and in the posterior cornu of the lateral ventricle in 3 cases. 13 tumors were large and in MRI the largest diameter was above 5 cm. Tumors located in the anterior cornu and pars centralis were removed using transcortical (10 cases) or transcallosal approaches (5 times). The tumor of the trigonum of ventricle was removed twice through superior parietal lobulus. Tumors of the posterior cornu were operated on via precuneus in order to save visual fields or through the occipital cortex. In 4 cases after removal of tumor the orifice in the frontal lobe was closed with fibrine glue. We totally removed tumors from lateral ventricles in 85% and subtotally in 15% of all cases. Histopathological examination revealed: astrocytoma anaplasticum in 5 cases, astrocytoma pilocyticum 4, oligodendroglioma 2, oligodendroglioma mixtum 1, papilloma plexus chorioidei 2, cystis epidermalis 2, subependymoma 1, ependymoma 1, pineocytoma 1 and haemangiona arterio-venosum 1. Two patients (10%) with diagnosis of anaplastic astrocytoma died after the operation as a result of ischemia and edema cerebri. During the follow-up examination, where the average time of observation was 3.7 years, 15 patients were found to be in a good condition (GR+MD), 1 patient was severely disabled (SD), 2 patients with anaplastic astrocytoma and pineocytoma died because of enlargement of the remnants of tumors left at first operation in spite of reoperation. Tumors of the lateral ventricle grow slowly and often achieve a large size before their clinical appearance. Most of tumors are accessible for a total or subtotal removal with acceptable morbidity and mortality rate after the operation. Long-term results depend on the size of resection and histopathological investigation.