Brain Tumor Res Treat.  2015 Oct;3(2):118-121. 10.14791/btrt.2015.3.2.118.

The Pterional-Transsylvian Approach for Tumor in the Temporal Horn: A Case Report

• Park JH
• Cho HR
• Seung WB
• Lee SH
• Park YS

• KMID: 2114658
• DOI: http://doi.org/10.14791/btrt.2015.3.2.118

Abstract

A variety of surgical approaches to temporal horn tumors of the lateral ventricle have been described. Magnetic resonance imaging (MRI) and angiography are the preferred modalities for preoperative evaluation and provide important information for the choice of surgical approach. A 59-year-old man was referred to our hospital due to confusion and gait disturbance. On enhanced MRI, a homogeneous enhanced solitary mass was observed within the temporal horn of the left lateral ventricle with transependymal extension. The lesion was accompanied by increased hypervascular tumor blush on preoperative cerebral angiography. Subtotal removal of the temporal horn tumor was performed because the lesion was identified as lymphoma during surgery. The postoperative course was un-eventful. The patient was referred to the oncology department for conventional chemotherapy. Adjuvant chemotherapy improved the clinical outcome. The pterional-transsylvian approach was beneficial for partial removal of the tumor and tissue diagnosis in this case.

Keyword

Lateral ventricle

MeSH Terms

Angiography
Animals
Cerebral Angiography
Chemotherapy, Adjuvant
Diagnosis
Drug Therapy
Gait
Horns*
Humans
Lateral Ventricles
Lymphoma
Magnetic Resonance Imaging
Middle Aged

Figure

• 

  Fig. 1 Preoperative nonenhanced axial (A), coronal (B), and gadolinium-enhanced axial (C and D) MRI scans demonstrate a large tumor of ovoid shape inside the left temporal horn with homogenous enhancement and peritumoral edema.

• 

  Fig. 2 Preoperative angiogram reveals significant tumor vascularity (red arrows).

• 

  Fig. 3 Intraoperative findings. A: The sylvian fissure is split to identify the inferior insular sulcus. The inferior insular sulcus was mapped with dotted black lines. B: The temporal horn is reached by dissecting the bottom of the inferior circular sulcus of the insula. IL, insula lumen; STG, superior temporal gyrus; MTG, middle temporal gyrus; ITG, inferior temporal gyrus.

• 

  Fig. 4 Postoperative gadolinium-enhanced MRI in axial (A and B) views 3 months after operation and chemotherapy shows the absence of tumor.

Reference

1. Wen HT, Mussi AC, Rhoton AL Jr, de Oliveira E, Tedeschi H. Surgical approaches to lesions located in the lateral, third, and fourth ventricles. In : Sekhar LN, Fessler RG, editors. Atlas of neurosurgical techniques-brain. 1st ed. New York: Thieme Medical Publishers Inc.;2006. p. 507–546.

2. Bertalanffy H, Krayenbuhl N, Wess C, Bozinov O. Ventricular tumors. In : Winn HR, editor. Youmans neurological surgery. 6th ed. Philadelphia: Elsevier;2011. p. 1534–1568.

3. Sincoff EH, Tan Y, Abdulrauf SI. White matter fiber dissection of the optic radiations of the temporal lobe and implications for surgical approaches to the temporal horn. J Neurosurg. 2004; 101:739–746.

4. Coppens JR, Mahaney KB, Abdulrauf SI. An anteromedial approach to the temporal horn to avoid injury to the optic radiation fibers and uncinate fasciculus: anatomical and technical note. Neurosurg Focus. 2005; 18:E3.

5. Papagno C, Miracapillo C, Casarotti A, et al. What is the role of the uncinate fasciculus? Surgical removal and proper name retrieval. Brain. 2011; 134(Pt 2):405–414.

6. D'Angelo VA, Galarza M, Catapano D, Monte V, Bisceglia M, Carosi I. Lateral ventricle tumors: surgical strategies according to tumor origin and development--a series of 72 cases. Neurosurgery. 2005; 56:1 Suppl. 36–45. discussion 36-45

7. Jelinek J, Smirniotopoulos JG, Parisi JE, Kanzer M. Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings. AJR Am J Roentgenol. 1990; 155:365–372.

8. Küker W, Nägele T, Korfel A, et al. Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol. 2005; 72:169–177.