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Surgical approaches to supratentorial tumors of the lateral and third ventricles are challenging because these structures cannot be reached without some kind of brain incision (33). Tumors within the lateral and third ventricles are deeply located, in close relation to critical brain structures, and in some cases, more complex trajectories have to be chosen. The approach to these tumors depends not only on the site of the lesion, but also on the presence or absence of hydrocephalus, the presumed histopathology of the lesion, its vascularization, and hemispheric dominance.
- Hydrocephalus: Because many patients present with obstructive hydrocephalus, urgent treatment of intracranial hypertension may be needed. The best way to treat intracranial hypertension is eliminating its cause (the tumor), but sometimes shunting or endoscopic procedures are needed as permanent or palliative measures.
- Amount of resection: As most ventricular tumors in children are benign, radical resection is the goal (10, 31, 47).
- Blood loss: Since many of these tumors occur in small children, blood loss can be a major problem, especially because some lesions are highly vascular. Staged tumor removal may need to be considered in some cases (7, 16, 22).
- Frozen section and tumors markers: Frozen section and tumors markers can be used to determine the need for radical resection for some ventricular neoplasms.
- Minimally invasive approaches: Endoscopic procedures may be useful in diagnosis and treatment of some lateral and third ventricle lesions (1, 26, 39).
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