Case reportComplications of interhemispheric transcallosal approach in children: Review of 15 years experience
Introduction
Studies of the corpus callosum were first undertaken by the humoral anatomists of ancient times who believed that the structure's function was purely of support—allowing air, phlegm, cerebrospinal fluid, and blood through the cavities of the brain [5]. This view persisted for a millennium until “traffic anatomists” such as Thomas Willis began thinking in terms of communication (or traffic) between the hemispheres. This was further detailed around the turn of the century with a report of a right-handed patient whose callosal lesion caused a left apraxia and a left-handed agraphia in the absence of aphasia. It was not until 1913, however, that German surgeon Brunner found that a unilateral occipital flap allowed the ligation of veins to the sagittal sinus and retraction of the hemisphere laterally with the subsequent cutting of the posterior portion of the corpus callosum allowing exposure of the pineal region.
In 1921, Dandy reported similar sectioning of the posterior two-thirds of the callosum in three patients with tumors [8]. One patient died “presumably of the shock due to the magnitude of the operation.” One mass was unable to be removed at all. The third, a 4 cm × 5 cm tuberculoma, was easily removed. French and Bucy reported five cases of septum pellucidum tumors all exposed by transcortical approaches [10]. In their publication they mentioned that the transcallosal approach could also have been utilized. Similarly, Cassinari and Bernasconi described 19 patients with third ventricular tumors, and favored the transcallosal approach [7].
Since the introduction of the operative microscope, the approach has become increasingly popular. There are a number of distinct advantages of the interhemispheric transcallosal corridor, especially in the pediatric patient population. The incidence of midline and intraventricular lesions are significantly higher in children. The approach allows access to the corpus callosum, septum pellucidum, lateral and third ventricles, and their periventricular structures, as well as the suprasellar region. This exposure can be accomplished without cortical destruction, theoretically decreasing the incidence of neurologic deficits and post-operative seizures. In addition, the approach is viable even without an enlarged ventricular system. Complications of this approach, however, include hemiparesis, seizures, memory disturbances, and, although not a complication, the inability to re-establish CSF circulation without having to insert a CSF diverting shunt. “Disconnection syndrome” is a rare complication that can also be seen after total callosotomy. However, it is unusual for the effects of disconnection after anterior callosotomy to represent significant handicap.
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Materials and methods
A retrospective chart review was performed. The records of children who have undergone anterior interhemispheric, transcallosal operations for deep midline lesions from 1989 to 2005 were reviewed. Surgery was performed at the Children's Hospital Los Angeles or the Children's Hospital San Diego. These years were chosen given the regional availability of high-resolution magnetic resonance (MR) imaging.
At the time of surgery, each patient was placed in a lateral decubitus position with the head
Results
The series included 65 patients whose pathology consisted of 31 astrocytomas of varying types, 7 arachnoid cysts, 6 arteriovenous malformations, 4 teratomas, and 4 choroid plexus tumors. Smaller numbers of ependymomas, meningiomas, gangliogliomas, cavernomas, sarcomas, and craniopharyngiomas were also included (Table 1). Pineal tumors were not included in this series. The ages ranged from newborn to 18 years with a mean of 8.2 years and included 38 (58.5%) males and 27 (41.5%) females. Minimum
Discussion
A review of the literature in the microsurgery era, since the mid-1970s, reveals some series that provide information regarding the incidence of complications related to this approach. Scattered throughout the literature is the occurrence of hemiparesis, memory loss, and mutism, but few series actually detail morbidity [18], [19]. No literature could be found with regard to post-operative seizures, and there is only occasional mention of the need for permanent CSF diversion [4]. Additionally,
References (19)
- et al.
The interhemispheric transcallosal–transversal approach to the lesions of the anterior and middle third ventricle: surgical validity and neuropsychological evaluation of the outcome
Brain Cogn
(2004) Surgery of masses affecting the third ventricular chamber: techniques and strategies
Clin Neurosurg
(1986)- et al.
Surgery in and around the anterior third ventricle
- et al.
Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences
Neurosurgery
(1982) Advantages and disadvantages of the transcallosal approach to the III ventricle
Child Nerv Syst
(1990)The neursurgeon's interest in the corpus callosum
Complications of third ventricle surgery
Pediatr Neurosurg
(1992)- et al.
Tumori della parte anteriore del terzo venticolo
Acta Neurochir (Wien)
(1963) An operation for the removal of pineal tumors
Surg Gynecol Obstet
(1921)
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