Abstract

SEOANE, Pablo et al. Utilización de la vía transcoroidal para craneofaringioma recidivado. Rev. argent. neurocir. [online]. 2008, vol.22, n.1. ISSN 1850-1532.

Objective. To describe the surgical anatomy of transcallosal transchoroidal approach to the third ventricle. The other corridors are also analyzed and compared. To present two cases of relapsing craniopharyngiomas treated through this approach. Material and methods. Three fixed and injected brains were prepared to study the involved structures. The clinical reports of two patients with relapsing craniopharyngiomas treated in our Service were analyzed. Both were giant and involved the anterior third ventricle and were classified after the scales of Samii and Yasargil. Results. The velum interpositum adheres to the fornix by the tenia fornices and to the thalamus by the tenia thalami. It consists of three layers. The superior lays under the fornix. The intermediate is the vascular layer and contains the internal cerebral veins and the posteromedial choroidal arteries. The third forms the roof of the third ventricle and carries the chorioid plexus of the third ventricle. The transchoroidal approach goes through the tenia fornices, opens the tree layers of the tela chorioidea passing between the internal cerebral veins, without sacrificing vascular structures. In both patients it could be possible to reduce partially the tumor, empty the cysts, and leave an indwelling catheter with reservoir draining the cysts. In one patient there is no relapse in 11 months. By the other, sporadic punctures (every 5-6 months) of the reservoir are needed to drain the cyst, when the patient becomes symptomatic, after 20 months of follow up. Conclusion. The transchoroidal corridor is not the preferred election approach for the surgical treatment of craniopharyngiomas. However, in recidivant cases, postoperative and scar tissue in the tumoral loge may hinder the identification of vascular, nervous and functional structures; the selection a "virgin" approach that allows a correct identification of these structures is desirable. The transchoroidal corridor seems a valid alternative for the surgical treatment of some recidivant craniopharyngiomas.

Keywords : Craniopharyngiomas; Transcallosal approach; Transchoroidal corridor; Third ventricle.

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