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

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.

Quantification And Comparison Of Telovelar And Transvermian Approaches To The Fourth Ventricle

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-202-ONS-207 ◽  
Author(s):  
Vivek R. Deshmukh ◽  
Eberval Gadelha Figueiredo ◽  
Puspha Deshmukh ◽  
Neil R. Crawford ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Angle Of Attack ◽  
Working Environment ◽  
Posterior Arch ◽  
Vertical Angle ◽  
Horizontal Angle ◽  
Surgical Exposure ◽  
Telovelar Approach

Abstract Objective: To quantify the exposure to the fourth ventricle obtained with the telovelar and transvermian approaches. Methods: The telovelar, with and without C1 posterior arch removal, and transvermian approaches were performed on six cadaveric heads. The area of surgical exposure was calculated from triangles formed by defined anatomic points. A robotic microscope was used to determine the “angle of approach” for the same points. Results: The maximal allowable vertical angle of attack to the obex of the fourth ventricle was significantly greater with the telovelar approach than with the transvermian approach (P < 0.002), but there was no difference at the rostral fourth ventricle. The maximal allowable horizontal angle of attack at the level of the obex, Luschka, and rostral fourth ventricle was significantly greater with the telovelar than with the transvermian approach (P < 0.001). Removal of the C1 posterior arch with the telovelar approach significantly increased the vertical angle of approach to the obex (P < 0.001) and rostral aspect of the fourth ventricle (P = 0.005) compared with the telovelar alone. The telovelar approach with C1 arch removal offered a larger working area than the transvermian approach (P < 0.001). Conclusion: Except for the vertical angle to the rostral aspect of the fourth ventricle, the telovelar approach provides greater angle of exposure in all planes than the transvermian approach. Removal of the C1 posterior arch obviates this sole advantage of the transvermian approach. The telovelar approach offers a corridor through noneloquent arachnoid planes and a safe and capacious working environment.

Telovelar approach: technical issues for large fourth ventricle tumors

2007 ◽  
Vol 23 (5) ◽  
pp. 555-558 ◽  
Author(s):  
B. J. Rajesh ◽  
B. R. M. Rao ◽  
G. Menon ◽  
M. Abraham ◽  
H. V. Easwer ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Technical Issues ◽  
Telovelar Approach

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.

Endoscopic telovelar approach to the fourth ventricle: anatomic study

2011 ◽  
Vol 35 (3) ◽  
pp. 341-349 ◽  
Author(s):  
Antonio Di Ieva ◽  
Mika Komatsu ◽  
Fuminari Komatsu ◽  
Manfred Tschabitscher
Keyword(s):  
Fourth Ventricle ◽  
Anatomic Study ◽  
Telovelar Approach

scholarly journals Surgical resection of fourth ventricular tumors. Comparison of the efficiency and safety of telovelar and median aperture approaches to the fourth ventricle

2019 ◽  
Vol 20 (4) ◽  
pp. 10-19
Author(s):  
K. N. Babichev ◽  
A. V. Stanishevskiy ◽  
D. V. Svistov ◽  
D. A. Averyanov ◽  
R. S. Lаkotko
Keyword(s):  
Postoperative Complications ◽  
Fourth Ventricle ◽  
External Ventricular Drain ◽  
Injury Rate ◽  
Extent Of Resection ◽  
Lesion Size ◽  
Significant Prognostic Factor ◽  
Military Medical Academy ◽  
Telovelar Approach ◽  
Median Approach

The study objective is to compare the efficacy and safety of the fourth ventricle tumor removal using median (through the median aperture) or telovelar approach.Materials and methods. The analysis included 41 patients with space-occupying lesion of the fourth ventricle operated in the Neurosurgery Clinic of S.M. Kirov Military Medical Academy in 2007–2018. The anatomical characteristics (size and extension) and manifestations of the fourth ventricle tumors, as well as surgical factors (surgical approach to the fourth ventricle) which affect the functional outcome of the treatment were estimated. Complications associated with the approach were assessed clinically using diffusion-weighted magnetic resonance imaging. Logistic regression and ROC analysis were used to analyze the anatomical factors and extent of resection as predictors that affect the worsening of gait disturbance, speech/swallowing deficits in the postoperative period.Results. The analysis revealed main advantages of the median approach in comparison to the telovelar approach: a lower frequency of C laminectomy; no need for prolonged constant tonsillar retraction; a shorter surgery duration and lower number of ischemic changes in the surgical area, caused by approach. Meanwhile the telovelar approach was used to remove lesions bigger in size. Other factors, such as tumor extension, the need to preliminary insertion of an external ventricular drain, the frequency of postoperative complications, the extent of resection and the functional outcomes did not differ significantly between the approaches. Lesion size ≥37.5 mm is a significant prognostic factor for speech/swallowing deficits after the surgery with sensitivity of 86 % and specificity of 84 %.Conclusion. Median aperture approach is a reasonable alternative to telovelar or transvermian approaches in the surgery of small fourth ventricle tumors (<30 mm). The median approach allows to reduce the surgical injury rate and the likelihood of postoperative complications. If a lesion has a size ≥37.5 mm, an increase speech/swallowing deficits should be expected.

scholarly journals Resection of pontine cavernous malformation by the full neuroendoscopic telovelar approach

2021 ◽  
Author(s):  
qiang cai ◽  
Yuyong Ke ◽  
Baowei Ji ◽  
Zhiyang Li ◽  
Wenju Wang ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Degree Of Freedom ◽  
Posterior Arch ◽  
Cavernous Malformations ◽  
Pontine Tegmentum ◽  
Telovelar Approach

Abstract Introduction: Lesions located in the fourth ventricle and/or pontine tegmentum were treated by telovelar approach under a microscope. However, it is difficult to access upper fourth ventricle from caudal to rostral without removal posterior arch of the atlas due to the vertical working angle of microscope. Neuroendoscope has a good degree of freedom in surgery and can reach this area easily. We tried to remove pontine cavernous malformation by full neuroendoscopic telovelar approach and the results was excellent. Clinical Presentation: Two women presented with dizziness and numbness and were diagnosed as pontine cavernous malformation. The cavernous malformations were removed by a full neuroendoscopic telovelar approach without removal of the posterior arch of the atlas. Conclusion: Neuroendoscope can remedy the flaws of microscopy and can provide greater application for the telovelar approach in pons and fourth ventricle.

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