İntraventriküler Tümörler: 25 Hastadaki Klinik Tecrübemiz

Öz

Amaç: Çalışmamızda, transkortikal, interhemisferik, telovelar ve transvermian yaklaşımlarla ameliyat edilen 25 intraventriküler lezyonlu hastanın uzun dönem cerrahi sonuçlarını paylaşmayı amaçladık.

Gereç ve Yöntemler: Bu çalışmada, Eylül 2016 ile Ocak 2025 tarihleri arasında kurumumuzda intraventriküler beyin tümörleri nedeniyle ameliyat edilen 25 hastanın retrospektif analizi yapılmıştır. Hastalar Kinevo 900 (Carl Zeiss Meditec, Oberkochen Almanya) kullanılarak opere edilmiş olup, tüm vakalarda ameliyat sırasında sodyum fluorescein uygulanmış ve optik nöronavigasyon sistemi (Stealth-Station S8, Medtronic, Minneapolis, MN, ABD) kullanılmıştır.

Bulgular: Çalışma popülasyonu 14 kadın (%56) ve 11 erkekten (%44) oluşmakta olup, ortalama 64.4 ay süreyle takip edilmiştir. En sık görülen tanı kolloid kist olup, altı hastada (%24) saptanmıştır. Diğer yaygın tümör tipleri arasında meningiomlar (dört hasta, %16), pilositik astrositomlar (üç hasta, %12), ependimomlar (üç hasta, %12), subependimomlar (iki hasta, %8) ve santral nörositomlar (iki hasta, %8) yer almaktaydı. Daha nadir olarak medulloblastom (bir hasta, %4), lenfoma (bir hasta, %4), soliter fibröz tümör (bir hasta, %4), diffüz astrositom (bir hasta, %4) ve diffüz orta hat gliomu, H3K27 alterasyonu gösteren orta hat gliomu (bir hasta, %4) saptanmıştır. Cerrahi yaklaşımlar transkortikal (n=10, %40), interhemisferik (n=10, %40), telovelar (n=4, %16) ve transvermian (n=1, %4) şeklindeydi. Postoperatif MRG bulgularına göre 24 hastada (%96) gross-total rezeksiyon, bir hastada (%4) subtotal rezeksiyon elde edilmiştir.

Sonuç: İntraventriküler tümörler, cerrahi yaklaşım tümör lokalizasyonu ve hasta anatomisine göre bireyselleştirildiğinde güvenli bir şekilde rezeke edilebilir ve olumlu sonuçlar elde edilebilir. Yüksek gross-total rezeksiyon oranımız ve düşük komplikasyon oranımız, maksimal güvenli rezeksiyonun tedavinin temel dayanağını oluşturduğunu göstermektedir.

Anahtar Kelimeler

• serebellar mutizm
• interhemisferik yaklaşım
• transkallozal yaklaşım

INTRAVENTRICULAR TUMORS: OUR CLINICAL EXPERIENCE IN 25 PATIENTS

Öz

Objective: We aimed to share our long-term surgical outcomes in 25 patients with intraventricular lesions who underwent surgery via transcortical, interhemispheric, telovelar, and transvermian approaches.

Materials and Methods: This study was conducted as a retrospective analysis of patients who underwent surgery for intraventricular brain tumors at our institution between September 2016 and January 2025. Patients were operated using the Kinevo 900 (Carl Zeiss Meditec, Oberkochen Germany) with intraoperative administration of sodium fluorescein, and an optical neuronavigation system (Stealth-Station S8, Medtronic, Minneapolis, MN, USA) was used in all cases.

Results: The study population consisted of 14 females (56%) and 11 males (44%), with a mean follow-up period of 64.4 months. The most frequent diagnosis was colloid cyst, observed in six patients (24%). Other common tumor types included meningiomas (four patients, 16%), pilocytic astrocytomas (three patients, 12%), ependymomas (three patients, 12%), subependymomas (two patients, 8%), and central neurocytomas (two patients, 8%). Less frequent pathologies were medulloblastoma , lymphoma , solitary fibrous tumor , diffuse astrocytoma, and H3K27 altered diffuse midline glioma, (each in one patient and 4%). Surgical approaches included transcortical (n=10, 40%), interhemispheric (n=10, 40%), telovelar (n=4, 16%), and transvermian (n=1, 4%). According to the postoperative MRI findings, gross-total resection was achieved in 24 patients (96%), and subtotal resection in one patient (4%).

Conclusion: Intraventricular tumors can be safely resected with favourable outcomes when the surgical approach is individualised based on tumor location and patient anatomy. Our high gross-total resection rate and low complication rate demonstrate that maximal safe resection constitutes the mainstay of treatment.

Anahtar Kelimeler

• interhemispheric approach
• transcallosal approach
• cerebellar mutism

Kaynakça

1. Agarwal A, Kanekar S. Intraventricular Tumors Semin Ultrasound CT MR. 2016;37(2):150-8.
2. Sayyahmelli S, Baran O, Uğurlar D, Kemerdere R, Antar V, Tanriverdi T. Intracranial intraventricular tumors: long-term surgical outcome of 25 patients. Turk J Med Sci 2017;47(1):76-84.
3. Waldron JS, Tihan T. Epidemiology and pathology of intraventricular tumors. Neurosurg Clin N Am 2003;14(4):469-82.
4. Kasowski H, Piepmeier JM. Transcallosal approach for tumors of the lateral and third ventricles. Neurosurg Focus 2001;10(6):E3.
5. Elwatidy SM, Albakr AA, Al Towim AA, Malik SH. Tumors of the lateral and third ventricle: surgical management and outcome analysis in 42 cases. Neurosciences (Riyadh) 2017;22(4):274-81.
6. Yaşargil MG, Abdulrauf SI. Surgery of intraventricular tumors. Neurosurgery 2008;62(6):SHC1029-SHC41.
7. Garcia RM, Ivan ME, Oh T, Barani I, Parsa AT. Intraventricular neurocytomas: a systematic review of stereotactic radiosurgery and fractionated conventional radiotherapy for residual or recurrent tumors. Clinical neurology and neurosurgery 2014;117:55-64.
8. Farnia B, Voong KR, Brown PD, Allen PK, Guha-Thakurta N, Prabhu SS, et al. Stereotactic radiosurgery for intraventricular brain metastases. Journal of neurosurgery 2014;121(Suppl2):26-34.

9. Mishra S, Mishra S, Regmi S, Katiyar V, Verma S, Satyarthee GD, et al. Comparative analysis of supratentorial intraventricular tumors in adults and pediatrics in a developing country: Clinicopathological Features, Surgical Management, and Outcomes. Neuropediatrics 2024;55(6):356-65.
10. Asgari S, Engelhorn T, Brondics A, Erol İ, Stolke D. Transcortical or transcallosal approach to ventricle-associated lesions: A clinical study on the prognostic role of surgical approach. Neurosurgical review 2003;26:192-7.
11. Dang DD, Rechberger JS, Leonel L, Rindler RS, Nesvick CL, Graepel S, et al. Anatomical step-by-step dissection of common approaches to the third ventricle for trainees: surgical anatomy of the anterior transcortical and interhemispheric transcallosal approaches, surgical principles, and illustrative pediatric cases. Acta Neurochir (Wien) 2023;165(9):2421-34.
12. Qian H, Lin S, Zhang M, Cao Y. Surgical management of intraventricular central neurocytoma: 92 cases. Acta Neurochir (Wien) 2012;154(11):1951-60.
13. Nair S, Gopalakrishnan CV, Menon G, Easwer HV, Abraham M. Interhemispheric transcallosal transforaminal approach and its variants to colloid cyst of third ventricle: Technical issues based on a single institutional experience of 297 cases. Asian J Neurosurg 2016;11(3):292-7.
14. Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle--a study of 105 cases. Surg Neurol 2002;57(5):295-302.
15. Milligan BD, Meyer FB. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery 2010;67(6):1483-96.
16. AlSharif M, Stroop R, Scholz M, Buchfelder M, Wiendieck K, Shiban E, et al. Clinical results and quality of life after transcortical versus transcallosal resection of adult lateral and third ventricle lesions: Long-term outcome. World Neurosurg 2023;179:194-e200.
17. Apuzzo ML, Chikovani OK, Gott PS, Teng EL, Zee CS, Giannotta SL, et al. Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences. Neurosurgery 1982;10(5):547-54.
18. Deshmukh VR, Figueiredo EG, Deshmukh P, Crawford NR, Preul MC, Spetzler RF. Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle. Neurosurgery 2006;58(4 Suppl 2):ONS-202-6.
19. Tomasello F, Conti A, Cardali S, La Torre D, Angileri FF. Telovelar Approach to Fourth Ventricle Tumors: Highlights and Limitations. World Neurosurg 2015;83(6):1141-7.
20. Maloumeh EN, Khoshnoud RJ, Ebrahimzadeh K, Tavassol HH, Salari S, Mousavinejad A, et al. Surgical management of the fourth ventricular tumors using telovelar approach and the role of neuroendoscopy: Post-operative outcome and long-term results in a series of 52 cases. Clin Neurol Neurosurg 2021;201:106419.
21. Hanaei S, Maroufi SF, Sadeghmousavi S, Nejati A, Paeinmahalli A, Ohadi MAD, et al. Telovelar vs. Transvermian approach for the fourth ventricle tumors: A systematic review and meta-analysis. Clin Neurol Neurosurg 2024;240:108259.
22. Setia V, Zeya M, Srivastava AK, Jagetia A. Cerebellar Mutism/Posterior Fossa Syndrome Following Resection of Posterior Fossa Tumor in Pediatric Patients: Assessing Pathophysiology, Risk Factors, and Neuroradiographic Features. Asian J Neurosurg 2025;20(2):260-8.