Minim Invasive Neurosurg 2011; 54(05/06): 236-242
DOI: 10.1055/s-0031-1297996
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Trans-Lamina Terminalis Approach to Third Ventricle using Supraorbital Craniotomy: Technique Description and Literature Review for Outcome Comparison with Anterior, Lateral and Trans-Sphenoidal Corridors

V. Krishna1, B. Blaker1, L. Kosnik1, S. Patel1, W. Vandergrift1
  • 1Division of Neurosurgery, Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
Further Information

Publication History

Publication Date:
25 January 2012 (online)

Abstract

Background:

The trans-lamina terminalis approach has been described to remove third ventricular tumors. Various surgical corridors for this approach include anterior (via bifrontal craniotomy), anterolateral (via supra-orbital craniotomy), lateral (via pterional craniotomy) and trans-sphenoidal corridors. Supra-orbital craniotomy offers a minimally invasive access for resection of third ventricular tumors.

Materials and Methods:

The trans-lamina terminalis technique through a supra-orbital craniotomy is described. Also, a literature review of clinical outcome data was performed for the comparison of different surgical corridors (anterior, antero-lateral, lateral, and trans-sphenoidal).

Results:

The operative steps and anatomic landmarks for supra-orbital craniotomy are discussed, along with 3 representative cases and respective outcomes. Gross total resection was achieved in 2 patients, and one patient required reoperation for recurrence. Based on the current literature, the clinical outcomes after supra-orbital craniotomy for trans-lamina terminalis approach are comparable to other surgical corridors.

Conclusions:

The supra-orbital craniotomy for trans-lamina terminalis approach is a valid surgical choice for third ventricular tumors. The major strengths of this approach include minimal brain retraction and direct end-on view; however, the long working distance is a major limitation. The clinical outcomes are comparable to other surgical corridors. Sound understanding of major strengths, limitations, and strategies for complication avoidance is necessary for its safe and effective application.