Transcallosal-lateral ventricle-choroid fissure approach for excising large pineal region tumors extending into the third ventricle: experience in 15 pediatric cases.

Pineal region is deep located and tightly connected with surrounding important nerves, blood vessels, and other critical structure. Tumors in the regions are more commonly observed in children with complex pathology, difficult surgery, and poor prognosis. However, excision surgery on large tumor in the pineal region and extending into the third ventricle is characterized by high difficulty and uneasy treatment. Related experience and knowledge about excising large tumor in children pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach was described in the paper. Clinical data of 15 children patients with large tumors in pineal region which extending into the third ventricle treated by our group from 2011 to 2015 was retrospectively analyzed (< 15 years of age, tumor size > >3 × 3 × 3 cm3). Fifteen cases underwent tumor excision with surgery by transcallosal-lateral ventricle-choroid fissure approach including 11 male patients and 4 female patients with average age of 9.1 years and tumor volume from 3 × 3 × 3 to 5 × 6 × 7 cm3. They were assessed according to postoperative clinical symptom remission rate, blood loss during surgery, tumor removal rate, postoperative recurrence rate, etc. as indicators. Five cases belonged to germ cell tumors, 4 for teratoma, 1 for malignant teratoma, 2 for glioma, 2 for meningioma, and 1 for pineocytoma. Surgical total excision rate was 100%, while the mean intraoperative blood loss was about 300 ml. No case was dead due to surgery, and all cases had good postoperative recovery. Children patients are characterized by less blood than adults, larger volume size during surgery treatment, poor postoperative anti-infectious ability, etc. High requirements are proposed on surgery treatment, by long-term clinical exploration and experience accumulation. Our group believes that surrounding structures such as veins and dome are stretched and stimulated rarely in excision of children in large and medium tumor in pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach; thereby, the tumor can be completely excised, and larger veins and other important structures can be well-preserved with fewer complications, high full cut rate, and rapid recovery.