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Third Ventricular Cavernous Malformations: Approach Selection for Minimally Invasive Resection and Systematic Review.

Benjamin Fixman1, Danielle Levy, Ishan Shah

  • 1Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles , California , USA.

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Summary

Minimally invasive techniques like supraorbital translamina terminalis and port-based transcortical approaches offer safe and effective resection of third ventricular cavernous malformations (TVCMs). These methods complement traditional surgeries, achieving good outcomes for deep-seated brain lesions.

Keywords:
CavernomaCavernous malformationEndoscopeSystematic reviewThird ventricle

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Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Minimally Invasive Procedures

Background:

  • Cavernous malformations (CMs) are benign central nervous system vascular lesions.
  • Ventricular involvement is rare (<10%), with third ventricle CMs posing surgical access challenges.
  • Symptomatic third ventricular cavernous malformations (TVCMs) require effective and safe resection strategies.

Purpose of the Study:

  • To describe the institutional experience with 3 patients treated for symptomatic TVCMs.
  • To review literature on minimally invasive surgical approaches for TVCM resection.
  • To evaluate the feasibility and outcomes of adapted minimally invasive neurosurgical techniques for TVCMs.

Main Methods:

  • Case series of 3 patients with TVCMs, including demographic, symptomatic, and surgical outcome data.
  • Systematic literature review following PRISMA guidelines using PubMed and Embase databases.
  • Analysis of minimally invasive approaches: supraorbital keyhole endoscopic-assisted resection (translamina terminalis) and port-based transcortical exoscopic-assisted resection.

Main Results:

  • All 3 institutional patients achieved gross total resection without complications or permanent memory deficits.
  • Systematic review of 51 additional patients showed gross total resection in 86.8% via various approaches.
  • Minimally invasive techniques demonstrated feasibility and safety, complementing traditional methods for TVCM treatment.

Conclusions:

  • Minimally invasive neurosurgical techniques, including supraorbital translamina terminalis and port-based transcortical approaches, are feasible for TVCM resection.
  • These adapted techniques offer reasonable safety and surgical outcomes, comparable to traditional open cranial approaches.
  • Successful resection of deep-seated TVCMs can be achieved with careful selection and application of minimally invasive strategies.