A comparative study of anterior trans-callosal and frontal trans-cortical surgical approaches in the management of lateral intra-ventricular tumors: functional outcomes and extent of resection

Abstract

Abstract Background Lateral intra-ventricular tumors pose significant surgical challenges owing to their deep-seated location and close relationship with eloquent neural structures. The most commonly used surgical corridors include transcortical and transcallosal approaches. Although these techniques differ fundamentally in terms of cortical, callosal, and subcortical disruption, both continue to be widely utilized in the management of lateral ventricular tumors. The present study does not presuppose biological equivalence between these approaches; rather, it examines their practical clinical implications within a real-world surgical context, in which approach selection is influenced by factors such as tumor location and size, ventricular anatomy, and surgeon experience. The objective of this study is to compare postoperative functional outcomes and extent of resection achieved using both approaches. Results The study included 27 cases (16 males and 11 females). Mean age at diagnosis was 25.33 years (range 5–41). Followed-up for 12 months post-operative. Tumors were predominantly located in ventricular body ( n = 23) with fewer cases in frontal horn ( n = 4). Main pathologies were central neurocytomas (12 patients 44.4%), ependymomas (6 patients 22.2%), and subependymal giant cell astrocytoma (SEGA) (4 patients 14.8%). Excision was gross total resection (GTR) n = 15 (transcallosal group n = 8—transcortical group n = 7) and partial resection n = 10 (transcallosal group n = 4—transcortical group n = 6). 2 case mortalities were recorded. Postoperative intra-ventricular hemorrhage n = 17 (transcallosal group n = 10—transcortical group n = 7), Postoperative Glasgow coma Scale (GCS) 11.28 ± 3.59 range from (5–15), postoperative seizures n = 13 (transcallosal group n = 6—transcortical group n = 7), motor deficits ( n = 4), cognitive affection at 12th month postoperative n = 6 (transcallosal group n = 4—transcortical group n = 2), recurrence cases n = 7 (transcallosal group n = 4—transcortical group n = 3). Causes of death included postoperative intraventricular hemorrhage with refractory hydrocephalus ( n = 1), and systemic medical complications unrelated to the surgical procedure ( n = 1). Conclusions In our series, transcallosal approach was associated with a higher incidence of postoperative cognitive impairment compared with transcortical approach. No significant differences were observed between two approaches with respect to postoperative seizures, motor outcomes, GCS, or extent of resection. Additionally, partial tumor resection was associated with increased risk of postoperative hemorrhage and tumor recurrence.