Anterior third ventricular colloid cyst - transcallosal approach

25 yr old lady with one episode of hydrocephalic attack/seizure [history not very discriminating] and attacks of headaches since 10 days.
CT scan - hyperdense anterior third ventricular lesion.

MRI - looked like a colloid cyst to me. Roops thought it could be cranio

Surgery - Right frontal parasagittal craniotomy[not crossing midline], interhemispheric transcallosal approach, transforaminal excision of lesion. Intraop impression: craniopharyngioma?! The viscid liquid contained white specks similar to that in some cranios.

Surgeons: I, VS Hari, Gomathy Shankar.

problems encountered:

1. change of plan - wanted to use right lateral position with head flexed up laterally to take advantage of gravity dependant retraction since self retaining retractors are currently unavailable but gave up fearing disorientation. May be next time. [Ability to operate with horizontal hand position should be a significant advantage]


2. Had difficulty finding foramen of monroe [? lifted up and adesions], and some difficulty orienting in the ventricle entered [left]. [grade 3/4 frust!] Initial attempted septal fenestration resulted in a small area of injury to left caudate ependymal surface.
   
3. End op hyperthermia [39.4 deg] and tachycardia [145/mt] due to occlusive drapes and air conditioning malfunction.

Post op - No deficits.

Final histopathology: Colloid cyst.

• Craniotomy need not be across midline - avoids sinus injury, saves a couple of burr holes. but has to be really reach midline - expose lateral edge of sinus.
• interhemispheric entry was precoronal as planned on preop mri and veins.