Outcome of open transcortical approach in the management of intraventricular lesions

To evaluate the outcome of management of intraventricular lesions operated by an open transcortical [nonendoscopic] approach. Case series. Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2009 to December 2011, with six months follow-up. All cases with lesions in the lateral ventricle and anterior third ventricle operated by open transcortical approach, were included after informed consent. Total excision of the lesion was attempted in all cases. Patients were analyzed for outcome in terms of establishment of diagnosis, completeness of resection, morbidity and mortality. A total of 33 patients were operated. Twenty three were males and 10 were females. Colloid cyst was diagnosed in 14 patients [42%], giant cell astrocytoma and choroid plexus papilloma in 4 cases each and subependymoma and central neurocytoma in 2 cases each, epidermoid, choroid plexus carcinoma, oligodendroglioma, metastasis, meningioma, ependymoma and cavernous hemangioma in one patient each. The overall outcome could be labeled as good in 24 out of 33 cases [73%] and in 8 cases [24%] it was fair. One patient died due to ventriculitis and was categorized as poor outcome [3%]. Postoperative complications included meningitis, seizures, intraventicular haemorrhage, subdural collection and transient hemiparesis. Nine patients had persistent hydrocephalus requiring ventriculoperitoneal shunt. Conventional open transcortical approach is still effective in getting conclusive biopsy or near total excision of the lesion with minimum morbidity.

Intramedullary spinal tuberculoma

Spinal intradural intramedullary tuberculoma is extremely rare entity of tuberculosis involving the nervous system. Because of its atypical symptomatology, it must be considered in differential diagnosis of spinal cord lesions, especially where prevalence of tuberculosis is high. In this case report this atypical disease is described where good outcome was achieved by surgical excision of the intramedullary lesion followed by antituberculous therapy