Tumors of the third ventricle: review of 262 cases

The data from 262 cases of third ventricle (V3) tumors treated in 21 Depart ments of Neurosurgery in France between 1980 and 1995 were collected in thi s series. These tumors were frequent in young adults, and 17.5 % of the pat ients were children. Colloid cysts (55 %) and gliomas (19 %) were the most frequent lesions. Other tumors were rare, or exceptonnal. Clinical presentation - The duration of symptoms was short in time, despite these lesions were usually benign. Most of cases were revealed by intracra nial hypertension (63 %), sometimes with a paroxystic or positional evoluti on. Neuropsychological signs (48 %) were undoubtedly under-estimated, revea ling the disease in only 10 % of cases. Ophthalmologic signs and endocrine disorders were infrequent. This feature is related to the selection of pati ents in this series, as tumors arising from the floor of the third ventricl e or from the optic chiasm were excluded. Endocrine disorders were frequent with gliomas (30 %). Therapeutic management - In half of the patients, hydrocephalus was absent or mild and was ruled out after the treatment of the ventricular lesion. Ho wever, 12 % of patients required a shunt procedure after the treatment of t he ventricular lesion. A stereotactic procedure was performed in 63 patient s, 12 had ventriculoscopy, and a direct surgical approach to the V3 was per formed in 200 patients, sometimes after the failure of stereotactic or endo scopic procedures. Thirty sir patients received no treatment. The patients were operated on via a transcortical approach (159 cases), or via the anter ior transcallosal route (35 patients). Postoperative course was uneventful in 67 % of rite patients, complications were recorded in 24 % of patients. Mortality and morbidity - The overall mortality in the national series is 1 3.7 % (36/262 died). The death occur red before any treatment (4 patients), or was directly correlated to the surgical procedure (13 cases), to long-t erm complications of hydrocephalus (2 patients), to general complications ( 7 patients), or to recurrence of the tumor (10 cases). The final outcome an alysis recorded neurological impairment in 29 % of cases, neuropsychologica l deficit in 50 % of patients, and residual endocrine disorders in 19 %. So cial independence was recovered by 86 % of patients, 76 % of them returned to work, 72 % of students returned to normal school attendance . The long-t erm neurological outcome was better with the transcallosal approach. No con clusion was possible concerning neuropsychological outcome, as postoperativ e neuropsychological assessment was not available for most of the patients operated on with the transcortical approach. Prognosis - The results of treatment were evaluated only for the most frequ ent lesions (colloid cysts and gliomas). The outcome was worse for gliomas when compared to colloid cysts, considering mortality (13 % vs 8 %), neurol ogical impairment (36 % vs 21 %), residual endocrine disorders (34 % vs 0 % ), and ability to return to work (83 % vs 56 %).