Craniopharyngiomas of the third ventricle: Trans-lamina terminalis approach

OBJECTIVE: Craniopharyngiomas usually grow on the cisternal surface of the hypothalamic region; these tumors can also grow from the infundibulum or tu ber cinereum on the floor of the third ventricle, developing exclusively in to the third ventricle. The aim of the present work was to establish the us efulness of the pterional trans-lamina terminalis approach for the removal of these tumors. METHODS: Eight patients who were surgically treated for craniopharyngiomas located exclusively within the third ventricle were considered. The initial symptoms were acute hydrocephalus in two cases, psychological disturbances in two, amenorrhea in two, headaches in one, and hypopituitarism in one. T he diagnoses were established, in all cases except one, with magnetic reson ance imaging. In all cases, the tumor completely filled the third ventricle . RESULTS: Total removal of the lesion was achieved in seven cases. One patie nt underwent partial removal. In the immediate postoperative period, no maj or complications were observed. Five patients required replacement hormonal therapy. All patients returned to a normal life. Many months after surgery , two patients exhibited psychological disturbances and died, the first bec ause of voluntary withdrawal of replacement therapy (12 mo after surgery) a nd the second because of a severe imbalance in body fluids and electrolytes , with a subsequent hyperosmolar coma (27 mo after surgery). Only one patie nt who underwent initial total removal experienced a small recurrence of th e lesion (30 mo after surgery); after 3 years, the lesion exhibited unchang ed size. CONCLUSION: In our experience, the trans-lamina terminalis approach is a va lid choice for the removal of purely intraventricular craniopharyngiomas. T hese tumors can be removed without significant sequelae related to the surg ical approach. The proximity to the hypothalamus requires accurate neuroend ocrine and electrolyte control in the postoperative period, in some cases e ven years after surgery.