Telovelar approach for microsurgical resection of fourth ventricular subependymoma arising from rhomboid fossa: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V5
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Fourth Ventricle ◽  
Total Resection ◽  
Tela Choroidea ◽  
Safe Technique ◽  
Microsurgical Resection ◽  
Cerebellomedullary Fissure ◽  
Telovelar Approach ◽  
Ventricular Tumors ◽  
Rhomboid Fossa ◽  
Neurologically Intact

Fourth ventricular tumors have traditionally been removed via transvermian approaches, which can result in potential dysequilibrium and mutism. The telovelar approach is an excellent alternative to widely expose fourth ventricular tumors without transgressing the cerebellar vermis. This is achieved by opening the cerebellomedullary fissure and incising the tela choroidea and inferior medullary velum, which form the lower half of the roof of the fourth ventricle. In this operative video manuscript, the authors demonstrate microsurgical resection of a fourth ventricular subependymoma arising from the rhomboid fossa via the telovelar approach. The key technical nuance in this video is to demonstrate a gentle and safe technique to identify a dissectable plane to peel the tumor off of the rhomboid fossa using a microspreading technique with fine micro-bayonetted forceps. A gross-total resection was achieved, and the patient was neurologically intact.The video can be found here: https://youtu.be/ZEHHbUGb9zk.

Surgical treatment of the tumors of the fourth ventricle through telovelar approach

2018 ◽  
Vol 20 (2) ◽  
pp. 8-16 ◽  
Author(s):  
A. V. Kalinovskiy ◽  
S. V. Chernov ◽  
A. V. Zotov ◽  
A. R. Kasymov ◽  
E. V. Gormolysova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Brain Stem ◽  
Fourth Ventricle ◽  
Radical Resection ◽  
Adult Patients ◽  
Study Objective ◽  
Results Of Treatment ◽  
Telovelar Approach ◽  
Ventricular Tumors

The study objectiveis analysis of surgical treatment results of adult patients with tumors of the fourth ventricle and determination of predictors of unsuccessful outcomes.Materials and methods.In the present study we review results of treatment of 33 adult patients with tumors of the fourth ventricle, which were operated via telovelar approach in Federal Neurosurgical Center (Novosibirsk). The most common symptoms included hydrocephalus (54.5 %), cerebellar dysfunction (33.3 %), cranial nerve deficits (30.3 %). The tumor size was more than 40 mm in 22 cases (66.7 %). The brain stem invasion was occurred in 21 cases (63.6 %).Results.23 tumors were removed totally (69.7 %). Hydrocephalus was regressed in 17 cases (94.5 %). Cerebellar mutism did not occur in any patient. Conclusion.Predictors of poor result may be brain stem invasion, non-radical resection of tumor and preoperative hydrocephalus. We suggest, that the preoperative hydrocephalus should not been operated in the most cases of the fourth ventricular tumors.

scholarly journals Retractorless interforniceal approach for microsurgical resection of a papillary tumor of the pineal region: operative video and technical nuances

2021 ◽  
Vol 5 (1) ◽  
pp. V12
Author(s):  
James K. Liu ◽  
Neil Majmundar
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Lateral Position ◽  
Pineal Region ◽  
Gross Total Resection ◽  
Cerebral Aqueduct ◽  
Papillary Tumor ◽  
Total Resection ◽  
Microsurgical Resection ◽  
Neurologically Intact

In this illustrative video, the authors demonstrate microsurgical resection of a papillary tumor of the pineal region using a retractorless interforniceal approach via the anterior interhemispheric transcallosal route. The tumor presented to the posterior third ventricle occluding the cerebral aqueduct, resulting in obstructive hydrocephalus. The retractorless interforniceal approach is performed in the lateral position with BICOL collagen spacers to keep the corridor open. Gross-total resection was achieved, and the patient was neurologically intact without needing a permanent shunt. The operative nuances and pearls of technique for safe microdissection and gentle handling of the retractorless interforniceal approach are demonstrated. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2139.

scholarly journals Retrosigmoid Suprameatal Approach for Resection of Petrotentorial Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances

2019 ◽  
Vol 80 (S 03) ◽  
pp. S290-S291
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Cerebellopontine Angle ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Total Resection ◽  
Nerve Preservation ◽  
Microsurgical Resection ◽  
Neurologically Intact ◽  
Neurovascular Structures ◽  
Gain Access ◽  
Base Technique

Meningiomas are the second most common tumor to arise in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petrotentorial meningioma in the cerebellopontine angle via a retrosigmoid suprameatal approach. Drilling of the hyperostotic suprameatal tubercle was necessary to gain access to the dural origin and anterior petrosal extent of the tumor. The nuances of microsurgical and skull base technique are illustrated including microsurgical dissection of the tumor away from the brainstem and neurovascular structures, facial nerve preservation, and fat graft-assisted Medpor Titan reconstruction to prevent cerebrospinal fluid leakage. A gross total resection was achieved, and the patient was neurologically intact. In summary, the retrosigmoid suprameatal approach is an important strategy in the armamentarium for surgical management of petrotentorial meningiomas in the cerebellopontine angle.The link to the video can be found at: https://youtu.be/kwQP6BSYK7U.

Microsurgical Resection of Dorsal Pontine Cavernous Malformation: The Telovelar Approach Augmented by the Tonsillouvular Fissure Exposure: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Devi P Patra ◽  
Evelyn L Turcotte ◽  
Bernard R Bendok
Keyword(s):  
Cavernous Malformation ◽  
Neural Tissue ◽  
Complete Resection ◽  
Surgical Approaches ◽  
Suboccipital Craniotomy ◽  
Tela Choroidea ◽  
Microsurgical Resection ◽  
Telovelar Approach ◽  
Posterior Laminectomy ◽  
Good Exposure

Abstract Surgical approaches to lesions of the fourth ventricle (FV) have been modified over the years to reduce the complications associated with splitting the inferior cerebellar vermis (ICV) and disrupting the brainstem and critical surrounding structures.1-4 Two common approaches to lesions of this region include the transvermian approach (TVA) and telovelar approach (TeVA).2 The TVA was initially considered the conventional route of access to lesions of the FV1 but has been associated with significant risks, including possible gait ataxia and dysarthria.3 The TeVA is advantageous, as it involves dissection along natural clefts and division of non-neural tissue and provides good exposure of the superolateral recess with modest exposure of the rostral FV. The TeVA approach can be augmented by opening the tonsilouvular fissures (TUFs). This added dissection allows greater lateral and superior exposure with less need for retraction. In this operative video, we demonstrate a case in which we augmented the TeVA with a TUF dissection to access a dorsal pontine cavernous malformation. We performed a midline suboccipital craniotomy with a C1 posterior laminectomy. TUF dissection was followed by division of the tela choroidea (TC), which allowed for more lateral exposure of the FV and excellent visualization of the cavernous malformation without the need to traverse neural tissue. TeVA augmented by TUF dissection provided adequate access to the dorsal pons for complete resection of the cavernous malformation. The patient consented to the procedure as shown in this operative video and gave informed written consent for use of her images in publication. Anatomic images provided by courtesy of © The Rhoton Collection. http://rhoton.ineurodb.org/. Video © Mayo Foundation for Medical Education and Research, 2021. Used with permission.

scholarly journals Pontine cavernous malformation: microsurgery evading the floor of the fourth ventricle

2019 ◽  
Vol 1 (1) ◽  
pp. V15
Author(s):  
Abdullah Keleş ◽  
Mehmet Volkan Harput ◽  
Uğur Türe
Keyword(s):  
Fourth Ventricle ◽  
Cavernous Malformation ◽  
Total Resection ◽  
Middle Cerebellar Peduncle ◽  
Link Type ◽  
Postoperative Mri ◽  
First Choice ◽  
Cerebellar Peduncle ◽  
Neurologically Intact

This video demonstrates resection of a left pontine cavernous malformation that is abutting the floor of the fourth ventricle (f4V). Even though accessing the lesion through the f4V seems to be reasonable, we used a lateral supracerebellar approach through the middle cerebellar peduncle to preserve especially the abducens and facial nuclei. After total resection the patient was neurologically intact at the 3-month follow-up. Postoperative MRI revealed 3.5-mm pontine tissue between the cavity and f4V that appeared to be absent in preoperative MRI. Approaching pontine lesions through the f4V is not the first choice. In our opinion, the philosophy of safe entry zones is a concept to be reassessed.The video can be found here: https://youtu.be/1Jh6giZc-48.

Telovelar approach to the fourth ventricle: microsurgical anatomy

2000 ◽  
Vol 92 (5) ◽  
pp. 812-823 ◽  
Author(s):  
Antonio C. M. Mussi ◽  
Albert L. Rhoton
Keyword(s):  
Fourth Ventricle ◽  
Microsurgical Anatomy ◽  
Thin Sheets ◽  
Content Type ◽  
Lateral Recess ◽  
The Past ◽  
Tela Choroidea ◽  
Telovelar Approach ◽  
Formalin Fixed ◽  
Fine Print

Object. In the past, access to the fourth ventricle was obtained by splitting the vermis or removing part of the cerebellum. The purpose of this study was to examine the access to the fourth ventricle achieved by opening the tela choroidea and inferior medullary velum, the two thin sheets of tissue that form the lower half of the roof of the fourth ventricle, without incising or removing part of the cerebellum.Methods. Fifty formalin-fixed specimens, in which the arteries were perfused with red silicone and the veins with blue silicone, provided the material for this study. The dissections were performed in a stepwise manner to simulate the exposure that can be obtained by retracting the cerebellar tonsils and opening the tela choroidea and inferior medullary velum.Conclusions. Gently displacing the tonsils laterally exposes both the tela choroidea and the inferior medullary velum. Opening the tela provides access to the floor and body of the ventricle from the aqueduct to the obex. The additional opening of the velum provides access to the superior half of the roof of the ventricle, the fastigium, and the superolateral recess. Elevating the tonsillar surface away from the posterolateral medulla exposes the tela, which covers the lateral recess, and opening this tela exposes the structure forming the walls of the lateral recess.

Microsurgery of the Fourth Ventricle: Part 1

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 631-667 ◽  
Author(s):  
Toshio Matsushima ◽  
Albert L. Rhoton ◽  
Carla Lenkey
Keyword(s):  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Tela Choroidea ◽  
Cerebellar Peduncles ◽  
Cerebellomedullary Fissure ◽  
Relationship Of ◽  
The Relationship ◽  
Arteries And Veins ◽  
The Brain ◽  
4Th Ventricle

Abstract Operations on the 4th ventricle offer the potential for injury of the brain stem, cerebellum, cranial nerves, and major cerebellar arteries and veins. Twenty-five cadaver brains were examined using 3× to 25× magnification to define the relationship of these vital structures to the 4th ventricle. The 4th ventricle has a roof, a floor, and two lateral recesses. Most of the cranial nerves arise near the floor, which sits on the pons and medulla. The superior half of the roof, formed by the superior medullary velum, lingula, and cerebellar peduncles, is intimately related to the cerebellomesencephalic fissure, the superior cerebellar arteries, and the vein of the cerebellomesencephalic fissure. The inferior half of the roof, formed by the inferior medullary velum, tela choroidea, nodule, and uvula, is intimately related to the cerebellomedullary fissure, the posterior inferior cerebellar arteries, and the veins of the cerebellomedullary fissure. The lateral recesses and adjoining parts of the roof and floor are intimately related to the cerebellopontine fissures, the anterior inferior cerebellar arteries, and the veins of the cerebellopontine fissure. The cerebellar peduncles converge on and form a major part of the ventricular surface. The hili of the dentate nuclei abut on the superolateral recesses of the ventricle near the superior poles of the tonsils.

scholarly journals Telovelar approach to pediatric fourth ventricle tumors: feasibility and outcome.

2018 ◽  
Author(s):  
Ahmed Atallah Saad ◽  
Mohamed Reda Rady ◽  
Hazem Mostafa Kamal ◽  
Noha El-mansy ◽  
Mohamed F.m. Alsawy ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Telovelar Approach

scholarly journals Expanded Transsphenoidal Trans-Lamina Terminalis Approach to Tumors Extending Into the Third Ventricle: Technique Notes and a Single Institute Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Lei Cao ◽  
Wentao Wu ◽  
Jie Kang ◽  
Hui Qiao ◽  
Xiaocui Yang ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Radical Resection ◽  
Lamina Terminalis ◽  
Total Resection ◽  
The Third ◽  
Cerebrospinal Fluid Leaks ◽  
Ventricular Tumors ◽  
New Onset

ObjectThe trans lamina terminalis approach (TLTA) has been described as a way to remove third ventricular tumors. The aim of this paper was to analyze the feasible outcomes of TLTA applied to tumors extending into the third ventricle in our institute.MethodsSuprasellar tumors (n = 149) were treated by the extended endonasal approach from September 2019 to December 2020 in Beijing Tiantan Hospital. Eleven of the tumors were treated by TLTA or TLTA via the trans-chiasm-pituitary corridor (TCPC). The surgical technique notes of TLTA were described and indications and outcomes of the approach were analyzed.ResultsThere were 11 patients enrolled in the study, six with papillary craniopharyngiomas, two with adamantinomatous craniopharyngiomas, one with a germinal cell tumor (GCT), one with cavernous malformation and one with chordoid glioma. Four of the patients received a radical resection by TLTA alone, while seven of them received TLTA via the TCPC. Gross total resection was achieved in eight patients (72.7%), and partial resection in three patients (27.3%). Visual function was improved in four of the 11 patients (36.4%), was unchanged in five patients (45.5%), and deteriorated in two patients (18.2%). New-onset hypopituitarism occurred in seven patients (63.3%) and new-onset diabetes insipidus occurred in two patients (18.2%). Electrocyte imbalance were observed in six patients (54.5%) at post-operative week 2. There were no surgery-related deaths or cerebrospinal fluid leaks. Postoperative intracranial infection was observed in one patient (9.1%), and during the follow-up period, tumor recurrence occurred in one patient (9.1%).ConclusionThe expanded TLTA provides a feasible suprachiasm corridor to remove tumors extending into the third ventricle, especially for craniopharyngiomas. Sound understanding of the major strengths and limitations of this approach, as well as strategies for complication avoidance, is necessary for its safe and effective application.

scholarly journals Microsurgical treatment of a large posterior fossa arachnoid cyst

2020 ◽  
Vol 2 (3(September-December)) ◽  
pp. e592020
Author(s):  
Leopoldo Mandic Ferreira Furtado ◽  
José Aloysio da Costa Val Filho ◽  
François Dantas ◽  
Camila Moura De Sousa
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Motor Development ◽  
Fourth Ventricle ◽  
Open Surgery ◽  
Surgical Strategies ◽  
Development Delay ◽  
Microsurgical Resection ◽  
Cystoperitoneal Shunting ◽  
Endoscopic Fenestration

Introduction: Arachnoid cysts are fluid-filled malformations of the arachnoid tissue. A prevalence in children of 2,6% has been reported[2,3]. Surgical strategies of treatment include open surgery with cyst wall excision , endoscopic fenestration or cystoperitoneal shunting[1,4]. Methods: In this video case, we described the case of a 1 year and 7 months old child who presented with motor development delay, unable to walk, who underwent microsurgical resection of a large posterior fossa arachnoid cyst and communication with the fourth ventricle. Conclusion: Microsurgery approach provides a safe anatomic control over the cyst and the recognition of floor of the fourth ventricle.  

Sign in / Sign up

Export Citation Format

Share Document