الفهرس 
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Abstract
This is a prospective study which enrolled all the patients presenting with de novo lateral ventricular tumors. This study is concerned with the easiest exposure of the lateral ventricular tumors and to evaluate the safety and efficacy (total/near total exposure and removal of the tumor) of the 2 main approaches for the surgical excision of lateral ventricular tumors.
This study have included 40 patients during the period from February 2013 till January 2015. With a follow up period of 18 months. Patients were investigated by CT scan and MRI brain with/without contrast. We didn’t have specific criteria or bias in which approach should we use (Transcortical, Transcallosal and Neruroendoscopic), at the beginning of the study. Then, as time passes this study grew more confident in using transcallosal approach for exposure of the tumor in certain locations, rather than transcortical specially after the first year in our study (after 16 cases).We preferred the use of the transcallosal approach when the tumor was located in frontal horn, body, atrium, anterior part of the occipital horn in small number of cases. However, the transcortical approach was the better choice in temporal horn tumors and the posterior part of occipital horn located tumors, Moreover, we dismissed they use of endoscope as it defies our aim of gross total resection. However, the endoscope is a great tool but it requires a certain tumor’s characteristics to be easily operated by the endoscope, these characters were a tumor less than 2 cm, mild vascularity, soft and mainly cystic, which was difficult to predict and account for with preoperative assessment.
Demographically; there is a slight female predominance for tumors arising in the lateral ventricles. However, there is no specific age for this type of tumors, but it is more common in adults around the age of 30, as children usually have the ventricular tumors in the 4th ventricle. Patients suffering from lateral ventricular tumors will experience headache most of the time, but without raising any red flags in the beginning because it is usually mild headache. Accompanying symptoms are infrequent and not significant. The body and the atrium of the lateral ventricles are the most common site for tumors. Hence most of the lateral ventricle tumors attain huge sizes more than 4 cm due to, the large size of the lateral ventricles and the ability to accommodate big lesions. Hydrocephalus is almost always a common association with tumors of the lateral ventricle, which we recommend to attack the tumor first, to take advantage of the potential large space of the ventricles, where visualization of the cleavage plain is fairly easy. Plus, most cases had recovered normal CSF circulation once tumor was excised. However, only a very small percentage require postoperative CSF diversion when hydrocephalus was persistent. Lateral ventricle tumors are usually benign with 89% of the study cases, and attaining fairly large sizes. The 2 approaches that were used to attack the tumors, where transcortical and transcallosal. Each with their different morbidities. We categorized our patients morbidities, in short term complication and long term complication.
Transcortical approach, had a higher percentage in hemiplegia and hemiparesis due a technical fault of head position which was corrected later on in the study. In addition, we didn’t have the access to neuro-navigation, cortical mapping or cortical stimulation. Plus, the patients who had hemiplegia didn’t improve at all after 1 year follow up. While patients with hemiparesis improved from grade 2 to 3 in 1 year time. However, majority of cases recovered very well without any incidence of postoperative seizures, complications, with zero % recurrence. As all the patients were given antiepileptic drugs 1 week before operation and 6 months after.
While, the cases that were operated on with the transcallosal approach recovered even better, they experienced minimal impairment of working memory which wasn’t affecting their quality of their lives. Moreover, the behavioral changes were also subtle without any impact on their lives. It was an easy, less hustle, less bleeding and definitely least complications. Nevertheless, the most devastating complication postoperative was mutism, however it’s a rare complication. where the patient was conscious but couldn’t speak resulting in the absence or marked paucity of verbal outcome. Surprisingly all patients that suffered from mutism recovered perfectly in 2 months duration. We think that this complication was due to the large division of the corpous callosum, which then patients suffered from mutism due to the suppression of the limbic system.