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Published on: September 27, 2010
Complications of interhemispheric transcallosal approach in children: review of 15 years experience
Henry E Aryan1, Burak M Ozgur, Rahul Jandial
1Division of Neurosurgery, University of California, San Diego, CA 92103, USA. hearyan@ucsd.edu
Insights
The interhemispheric transcallosal approach is safe for pediatric brain tumors, with low rates of permanent complications like hemiparesis or seizures. This surgical corridor offers a versatile option for deep-seated lesions.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Cranial Surgery
Background:
- The interhemispheric transcallosal approach minimizes cortical injury for deep-seated brain lesions.
- Limited data exists on the morbidity associated with this surgical technique.
Purpose of the Study:
- To describe the 15-year surgical experience with the interhemispheric transcallosal approach in pediatric patients.
- To evaluate the morbidity and long-term outcomes of this approach for deep-seated lesions.
Main Methods:
- Retrospective review of pediatric patients undergoing interhemispheric transcallosal resection over 15 years.
- Data collection included intra-operative details, need for vein ligation, and post-operative outcomes.
- Outcomes assessed included hemiparesis, seizures, memory deficits, and cerebrospinal fluid (CSF) diversion.
Main Results:
- Sixty-five pediatric patients were identified.
- Transient hemiparesis was higher with parasagittal vein ligation (44.6%) but had no long-term impact.
- Overall permanent morbidity at 1 year was low (6.2%), including persistent hemiparesis, memory deficits, or refractory seizures.
Conclusions:
- The interhemispheric transcallosal corridor is a safe and versatile surgical approach for pediatric deep-seated lesions.
- This approach results in low rates of permanent post-operative morbidity in children.
Objective:
The interhemispheric transcallosal approach to deep-seated lesions in and around the ventricular system avoids cortical manipulation and injury. Few case series discuss the morbidity associated with this approach. This study describes the 15-year experience of the senior author in Southern California.
Methods:
All pediatric patients who have undergone interhemispheric, transcallosal resections of mass lesions over a 15-year period were identified. The surgical approach was uniform with respect to positioning of the patient. Intra-operative and post-operative data were collected retrospectively from the medical records. The need for bridging vein ligation as well as the incidence of hemiparesis, seizures, memory disturbances, and the need for subsequent cerebrospinal fluid (CSF) diversion were identified.
Results:
Sixty-five patients were identified. The incidence of transient post-operative hemiparesis appeared to be higher in those patients who required ligation of one or two parasagittal veins (44.6% versus 18.5%) with no difference in long-term outcome. Nineteen percent (18.5%) of patients had post-operative seizures; however, no long-term seizure disorder was identified. Nine percent (9.2%) had reports of transient short-term memory deficits. Thirty-four percent (33.8%) of patients required secondary operative intervention for CSF diversion. The total complication rate, including need for CSF diversion, transient hemiparesis, infection, post-operative seizures, and memory disturbance was 36.9%. By 1 year, the total number of patients with persistent hemiparesis, memory disturbance, or seizures refractory to medication was 4 (6.2%).
Conclusion:
This series demonstrates that the interhemispheric transcallosal corridor is a versatile and safe approach in childhood, resulting in low post-operative permanent morbidity.