Table 4.

Indications and pros and cons of different surgical approaches to the tumors extended to third ventricle.

Surgical approaches	Indications	Advantages	Disadvantages
Transcallosal interforniceal approach	Tumors favor the middle line and posterosuperior aspect of the third ventricles	Better for larger tumors and tumors that favor the posterosuperior aspect of the third ventricle Excellent window for the dissection of tumor from the hypothalamus bilaterally	Long work distance Cognitive impairment Limited visualization of the third ventricle floor and displaced optic chiasm from this superior viewpoint
Transventricular approach	Tumors favor the posterosuperior aspect of the third ventricles with dilated Monro’s Foramen or tumors extended into the lateral ventricle	1. Excellent visualization for larger tumors and tumors that favor the posterosuperior aspect of the third ventricle	Risk to the ipsilateral fornix and deep venous structures Long work distance Limited visualization of deep margin of the tumor
Anterior interhemispheric approach via TLTA	Tumors occupying the anteroinferior portion of the third ventricle without ACoA complex blocking lamina terminalis	Excellent visualization of tumors through lamina terminalis	Risks to the adjacent optic pathways, supraoptic nuclei of the hypothalamus, and columns of the fornix ACoA complex block TLTA
Subfrontal or pterion approach via TLTA	Tumors occupying the anteroinferior portion of the third ventricle without ACoA complex blocking lamina terminalis	Excellent visualization of contralateral wall of hypothalamus and third ventricle floor thought lamina terminalis	Limited visualization of the superior extent of tumor extension and ipsilateral wall of hypothalamus ACoA complex and ipsilateral A1 block TLTA
EEA via TCPC	Tumors favors sub-NCL part of the third ventricle	Excellent visualization of the infrachiasmic tumor little traction of optic chiasm	Long work distance Bad visualization of upper tumor to roof of third ventricle TCPC is narrow when chiasm prefixed CSF leaks
EEA via TLTA	Tumors favor supra-NCL part of the third ventricle without extending into lateral ventricle	Excellent visualization of the suprachiasmic tumor	1.High risk to optic chiasm for traction Limited visualization of infrachiasmic tumors Long wok distance CSF leaks

TLTA, translamina terminalis approach; TCPC, trans chiasm-pituitary corridor; EEA, extended endoscopic approach; ACoA, artery communicating artery; CSF, cerebrospinal fluid.