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Arthur Ward and R. Glen Spurling

cent, and all the patients are living. In the group of malignant gliomas, the operative mortality was 33 per cent and the ultimate mortality was 83 per cent at the end of 3 years. Araki 1 reported an operative mortality of 38.9 per cent for 36 cases of third ventricle tumor (including 20 pineal tumors) which he reviewed from the literature. 3 Of this group, 30 patients were operated on by a unilateral posterior transcallosal approach; 4 by a transventricular route; and 2 by resection of the occipital lobe. The operative mortality was 30–50 per cent by the first

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James Greenwood Jr.

case is desirable. The type of surgical approach used, while advantageous from the standpoint of minimizing brain trauma, was not as easy as the transcortical or transcallosal approach used for cysts of the 3rd ventricle. SUMMARY 1. A case of movable foreign body (bullet) in the 3rd ventricle and its extraction through the lamina terminalis has been presented. 2. Temporary postoperative mental or metabolic disturbances resulting in enormous appetite for food and fluids has been outlined. REFERENCES 1. Campbell , E

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Colloid Cysts of the Third Ventricle

Report of Seven Cases

James L. Poppen, Victor Reyes and Gilbert Horrax

experience in the operative removal of colloid cysts of the 3rd ventricle has been thoroughly reviewed by Weinberger and Boshes 29 in 1943. They collected 17 cases of surgical recoveries up to that date; their series did not include several reported cases. 2, 3, 13 Dandy, who had tried three different surgical routes in his early cases reserved a transcallosal approach for tumors that extended posteriorly in the 3rd ventricle, and stated that the frequency with which postoperative epilepsy occurred when the transcortical route was employed was a drawback not encountered

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Charles G. Drake

which were operated upon, 4 arose from the basilar bifurcation. One of these was successfully clipped. The 2nd presented as a 3rd ventricle tumor and was not discovered by a transcallosal approach. The remaining 2 patients died from brain stem softening, one after 2 unsuccessful attempts at clipping (Bohm) and the other in spite of successful occlusion (Norlén). Jamieson 5 has operated on 10 basilar aneurysms with only 2 long term survivors, both severely disabled. For completeness it can be recorded that in addition to the 7 basilar aneurysms from this unit (5

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Thomas H. Milhorat and Maitland Baldwin

cortex to open the lateral ventricle, and exposure of the 3rd ventricle through the foramen of Monro. Both procedures became standard techniques and both have endured with relatively little modification. Of the two, the transcallosal approach provides better exposure and is more direct; it is generally more dangerous. The transcortical approach 3, 6 avoids direct confrontation with the midline blood supply but provides limited access to the surgical target, removes significant amounts of cortical tissue, and introduces the risk of postoperative epilepsy. In

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Don M. Long and Shelley N. Chou

sign of increased intracranial pressure. The location of the neoplasm was apparent on the air study, which appears to be the best way to localize the mass definitively. Operative Technique In two of the patients a standard subfrontal approach was used first, to try to remove the tumor. In one of these patients the approach was extended to become subtemporal to expose a portion of the tumor anterior to the brain stem. Recurrence of the tumor in each case in the intraventricular position required reoperation via the transcallosal approach. Two of the adults

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William F. Chandler, Saeed M. Farhat and Francis J. Pauli

dexamethasone, the patient underwent a craniotomy with an interhemispheric transcallosal approach to the left thalamic region. The lateral ventricle was mildly enlarged and the thalamus was bulging and slightly discolored. An incision was made in the enlarged thalamus, and a tumor containing material with the classic white pearly appearance of an epidermoid was encountered at a depth of 5 mm. The tumor measured approx mately 3×3 cm, and with the aid of the dissecting microscope the tumor was gutted out and its capsule was resected. After removal of the tumor, the base of the

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Thomas M. Markwalder, Regula V. Markwalder and Hans M. Markwalder

who also presented a tumor of the foramen of Monro, and a meningioma of the posterior part of the third ventricle arising from the stalk of the plexus (which is more typical for the anterior location) reported by Jinnai, et al. 7 In 1971, Suga, et al., 12 reported a case that was successfully removed through an anterior transcallosal approach. Another meningioma of the third ventricle was presented by Sinha, et al., 11 in 1976. Including our case, only 31 meningiomas of the third ventricle have been reported in the literature. References 1

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transcallosal section on postoperative neuropsychological function. While the transcallosal approach was not employed in the case material reviewed in our article, Winston, et al., 3 have recently reviewed neuropsychological parameters in a group of four children with different intracranial lesions undergoing transcallosal operation. Although only one of these patients had preoperative evaluation, the postoperative evaluation (memory, visual perception, motor integration, and dexterity and sensory testing) in all four of these patients showed none of the features

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G. Robert Nugent, Ossama Al-Mefty and Sam Chou

vision, and a loss of upward gaze. A contrast ventriculogram performed because of shunt failure revealed prominent hydrocephalus, descent of the third ventricle, and apparent obstruction of the aqueduct ( Fig. 4 lower ). Because of abnormal calcification in the region of the pineal gland, it was believed that he possibly had a pineal tumor. This region was explored by a right parietal transcallosal approach but no tumor was found. Since revision of the shunt, the patient has done well except for a depressive neurosis. Comment Even though the occlusion and