Transcerebellomedullary fissure approach with special reference to the methods of dissecting the fissure

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Toshio Matsushima ◽  
Tooru Inoue ◽  
Takanori Inamura ◽  
Yoshihiro Natori ◽  
Kiyonobu Ikezaki ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Posterior Margin ◽  
Lateral Wall ◽  
Microsurgical Anatomy ◽  
Optimal Method ◽  
Content Type ◽  
Lateral Recess ◽  
Tela Choroidea ◽  
Opening Method ◽  
Fine Print

Object. The purpose of the present study was to refine the transcerebellomedullary fissure approach to the fourth ventricle and to clarify the optimal method of dissecting the fissure to obtain an appropriate operative view without splitting the inferior vermis. Methods. The authors studied the microsurgical anatomy by using formalin-fixed specimens to determine the most appropriate method of dissecting the cerebellomedullary fissure. While dissecting the spaces around the tonsils and making incisions in the ventricle roof, the procedures used to expose each ventricle wall were studied. Based on their findings, the authors adopted the best approach for use in 19 cases of fourth ventricle tumor. The fissure was further separated into two slit spaces on each side: namely the uvulotonsillar and medullotonsillar spaces. The floor of the fissure was composed of the tela choroidea, inferior medullary velum, and lateral recess, which form the ventricle roof. In this approach, the authors first dissected the spaces around the tonsils and then incised the taenia with or without the posterior margin of the lateral recess. These precise dissections allowed for easy retraction of the tonsil(s) and uvula and provided a sufficient view of the ventricle wall such that the deep aqueductal region and the lateral region around the lateral recess could be seen without splitting the vermis. The dissecting method could be divided into three different types, including extensive (aqueduct), lateral wall, and lateral recess, depending on the location of the ventricle wall and the extent of surgical exposure required. Conclusions. When the fissure is appropriately and completely opened, the approach provides a sufficient operative view without splitting the vermis. Two key principles of this opening method are sufficient dissection of the spaces around the tonsil(s) and an incision of the appropriate portions of the ventricle roof. The taenia(e) with or without the posterior margin of the lateral recess(es) should be incised.

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.

Comparison of the transvermian and telovelar approaches to the fourth ventricle

2004 ◽  
Vol 101 (3) ◽  
pp. 484-498 ◽  
Author(s):  
Necmettin Tanriover ◽  
Arthur J. Ulm ◽  
Albert L. Rhoton ◽  
Alexandre Yasuda
Keyword(s):  
Fourth Ventricle ◽  
Image Guidance ◽  
Surgical Approaches ◽  
Content Type ◽  
Lateral Recess ◽  
Telovelar Approach ◽  
Additional Exposure ◽  
Formalin Fixed ◽  
Fine Print ◽  
Foramen Of Luschka

Object. The two most common surgical routes to the fourth ventricle are the transvermian and telovelar approaches. The purpose of this study was to compare the microanatomy and exposures gained through these approaches. Methods. Ten formalin-fixed specimens were dissected in a stepwise manner to simulate the transvermian and telovelar surgical approaches. Stealth image guidance was used to compare the exposures and working angles obtained using these approaches. The transvermian and telovelar approaches provided access to the entire rostrocaudal length of the fourth ventricle floor from the aqueduct to the obex. In addition, both approaches provided access to the entire width of the floor of the fourth ventricle. The major difference between the two approaches regarded the exposure of the lateral recess and the foramen of Luschka. The telovelar, but not the transvermian, approach exposed the lateral and superolateral recesses and the foramen of Luschka. The transvermian approach, which offered an incision through at least the lower third of the vermis, afforded a modest increase in the operator's working angle compared with the telovelar approach when accessing the rostral half of the fourth ventricle. Conclusions. The transvermian approach provides slightly better visualization of the medial part of the superior half of the roof of the fourth ventricle. The telovelar approach, which lacks incision of any part of the cerebellum, provides an additional exposure to the lateral recesses and the foramen of Luschka.

Intraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery

1985 ◽  
Vol 62 (5) ◽  
pp. 772-775 ◽  
Author(s):  
Hwa-Shain Yeh ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Surgical Repair ◽  
Posterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Lateral Recess ◽  
Cerebellar Artery ◽  
Subarachnoid Blood ◽  
Basal Cisterns ◽  
Fine Print

✓ Three cases of ruptured aneurysm of the distal posterior inferior cerebellar artery (PICA) presenting with isolated intraventricular hematoma are reported. All of the aneurysms originated from the lateral medullary segment of the PICA and ruptured into the lateral recess of the fourth ventricle. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requisite for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.

Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 533-535 ◽  
Author(s):  
Jin Woo Chang ◽  
Jae Young Choi ◽  
Young Sul Yoon ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Fourth Ventricle ◽  
Gamma Knife Radiosurgery ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Segmental Demyelination ◽  
Content Type ◽  
Clinical Responses ◽  
Fine Print

✓ The purpose of this paper was to present two cases of secondary trigeminal neuralgia (TN) with an unusual origin and lesion location. In two cases TN was caused by lesions along the course of the trigeminal nerve within the pons and adjacent to the fourth ventricle. Both cases presented with typical TN. Brain magnetic resonance imaging revealed linear or wedge-shaped lesions adjacent to the fourth ventricle, extending anterolaterally and lying along the pathway of the intraaxial trigeminal fibers. The involvement of the nucleus of the spinal trigeminal tract and of the principal sensory trigeminal nucleus with segmental demyelination are suggested as possible causes for trigeminal pain in these cases. It is postulated that these lesions are the result of an old viral neuritis. The patients underwent gamma knife radiosurgery and their clinical responses have been encouraging to date.

Teratoma of the fourth ventricle

1973 ◽  
Vol 38 (3) ◽  
pp. 355-357 ◽  
Author(s):  
Robert J. Morelli
Keyword(s):  
Fourth Ventricle ◽  
Rare Case ◽  
Surgical Removal ◽  
Malignant Teratoma ◽  
Content Type ◽  
Fine Print

✓ The author reports a rare case in which a primary malignant teratoma presented as an obstructing mass in the fourth ventricle. The tumor was not cystic but well encapsulated, and a gross total surgical removal was accomplished. A fatal recurrence occurred within 3 months.

Fourth ventricular schwannoma

1990 ◽  
Vol 73 (5) ◽  
pp. 777-781 ◽  
Author(s):  
Gary Redekop ◽  
Kost Elisevich ◽  
Joseph Gilbert
Keyword(s):  
Fourth Ventricle ◽  
Content Type ◽  
Radiographic Features ◽  
Unusual Location ◽  
Pontomedullary Junction ◽  
Fine Print

✓ A schwannoma arising from the dorsum of the pontomedullary junction and presenting as an exophytic mass in the fourth ventricle is described. A ventricular schwannoma has not previously been reported in the literature. The presenting clinical and radiographic features and the pathology of this tumor are summarized, and an explanation is sought for its unusual location.

Fourth ventriculoceles with extracranial extension

1984 ◽  
Vol 61 (2) ◽  
pp. 348-350 ◽  
Author(s):  
Robert A. Fenstermaker ◽  
Uros Roessmann ◽  
Harold L. Rekate
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Outcome ◽  
Fourth Ventricle ◽  
Pathological Findings ◽  
Direct Communication ◽  
Content Type ◽  
Cyst Excision ◽  
Occipital Encephalocele ◽  
Fine Print

✓ The radiographic features and long-term clinical outcome in three patients who presented at birth with a cystic suboccipital mass in direct communication with the fourth ventricle are reviewed. The pathological findings in a fourth infant who died are also discussed. All surviving infants were treated with cyst excision and diversion of cerebrospinal fluid. The prognosis in these children, followed from 6 to 20 years, surpasses that of the more common occipital encephalocele, for which this entity could be mistaken. The morphogenetic implications relative to more common congenital lesions in this location are discussed.

Hydrocephalus due to membranous obstruction of the fourth ventricle

1971 ◽  
Vol 35 (6) ◽  
pp. 672-676 ◽  
Author(s):  
A. Loren Amacher ◽  
Larry K. Page
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Clinical Findings ◽  
Posterior Fossa Tumor ◽  
Cerebellar Development ◽  
Rare Entity ◽  
Content Type ◽  
Operative Findings ◽  
Membranous Obstruction ◽  
Fine Print

✓ Four patients with hydrocephalus due to membranous obstruction of the fourth ventricle are presented. This rare entity produced radiographic and clinical findings suggestive of posterior fossa tumor. Operative findings included normal cerebellar development and a translucent membrane just above the foramen of Magendie. Etiological possibilities are discussed.

Endoscopic removal of cysticercal cysts within the fourth ventricle

1999 ◽  
Vol 91 (2) ◽  
pp. 340-345 ◽  
Author(s):  
Marvin Bergsneider
Keyword(s):  
Fourth Ventricle ◽  
Treatment Options ◽  
Primary Treatment ◽  
Surgical Removal ◽  
Endoscopic Removal ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Mean ◽  
Optimum Management ◽  
Fine Print

✓ There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunt placement, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as an alternative to the standard suboccipital craniectomy for removal of cysticercal cysts within the fourth ventricle.A retrospective analysis of five consecutive endoscopic cases was performed. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative time was short and blood loss was insignificant. The endoscopic procedure was safe and associated with minimal postoperative discomfort in most patients.In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle should be considered as the primary treatment for this condition.

Isolated fourth ventricle as a complication of ventricular shunting

1978 ◽  
Vol 49 (6) ◽  
pp. 910-913 ◽  
Author(s):  
John C. Hawkins ◽  
Harold J. Hoffman ◽  
Robin P. Humphreys
Keyword(s):  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Normal Function ◽  
Shunt Malfunction ◽  
Cerebellar Dysfunction ◽  
Content Type ◽  
Isolated Fourth Ventricle ◽  
Ventricular Shunting ◽  
Fine Print

✓ Signs of cerebellar dysfunction combined with signs suggestive of shunt malfunction developed in three children with obstructive hydrocephalus. Shunt function was normal. In all cases, the cerebellar signs persisted and computerized tomography scans revealed enlargement of the fourth ventricle. Shunting of the fourth ventricle returned the patients to normal function.

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