Endoscopic telovelar approach to the fourth ventricle: anatomic study

Ieva, Antonio Di; Komatsu, Mika; Komatsu, Fuminari; Tschabitscher, Manfred

doi:10.1007/s10143-011-0371-0

Cited by 26 publications

(16 citation statements)

References 40 publications

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“…The feasibility of using endoscopy to perform a telovelar approach has been addressed by a report that addresses the endoscopic topographical anatomy of this region. 5 Because prior reports of endoscopic access to the fourth ventricle used the foramen of Magendie to enter that space, telovelar access by endoscopy has (in theory) the double advantage of minimizing tonsillar retraction and associated injury to the dentate nuclei, while also reducing the degree of telovelar opening required for visualization within the ventricle. 5,14 This method has not been used clinically but shows that minimally invasive surgery may become useful in treating tumors of the fourth ventricle.…”

Section: Technical Aspects Of the Telovelar And Transvermian Approachesmentioning

confidence: 99%

The surgical treatment of tumors of the fourth ventricle: a single-institution experience

Ferguson¹,

Levine

Suki

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Fourth ventricle tumors are rare, and surgical series are typically small, comprising a single pathology, or focused exclusively on pediatric populations. This study investigated surgical outcome and complications following fourth ventricle tumor resection in a diverse patient population. This is the largest cohort of fourth ventricle tumors described in the literature to date. METHODS This is an 18-year (1993-2010) retrospective review of 55 cases involving patients undergoing surgery for tumors of the fourth ventricle. Data included patient demographic characteristics, pathological and radiographic tumor characteristics, and surgical factors (approach, surgical adjuncts, extent of resection, etc.). The neurological and medical complications following resection were collected and outcomes at 30 days, 90 days, 6 months, and 1 year were reviewed to determine patient recovery. Patient, tumor, and surgical factors were analyzed to determine factors associated with the frequently encountered postoperative neurological complications. RESULTS There were no postoperative deaths. Gross-total resection was achieved in 75% of cases. Forty-five percent of patients experienced at least 1 major neurological complication, while 31% had minor complications only. New or worsening gait/focal motor disturbance (56%), speech/swallowing deficits (38%), and cranial nerve deficits (31%) were the most common neurological deficits in the immediate postoperative period. Of these, cranial nerve deficits were the least likely to resolve at follow-up. Multivariate analysis showed that patients undergoing a transvermian approach had a higher incidence of postoperative cranial nerve deficits, gait disturbance, and speech/swallowing deficits than those treated with a telovelar approach. The use of surgical adjuncts (intraoperative navigation, neurophysiological monitoring) did not significantly affect neurological outcome. Twenty-two percent of patients required postoperative CSF diversion following tumor resection. Patients who required intraoperative ventriculostomy, those undergoing a transvermian approach, and pediatric patients (< 18 years old) were all more likely to require postoperative CSF diversion. Twenty percent of patients suffered at least 1 medical complication following tumor resection. Most complications were respiratory, with the most common being postoperative respiratory failure (14%), followed by pneumonia (13%). CONCLUSIONS The occurrence of complications after fourth ventricle tumor surgery is not rare. Postoperative neurological sequelae were frequent, but a substantial number of patients had neurological improvement at long-term followup. Of the neurological complications analyzed, postoperative cranial nerve deficits were the least likely to completely resolve at follow-up. Of all the patient, tumor, and surgical variables included in the analysis, surgical approach had the most significant impact on neurological morbidity, with the telovelar approach being associated with less morbidity.

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Section: Technical Aspects Of the Telovelar And Transvermian Approachesmentioning

confidence: 99%

The surgical treatment of tumors of the fourth ventricle: a single-institution experience

Ferguson¹,

Levine

Suki

et al. 2018

Journal of Neurosurgery

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“…However, in 2010, Di Ieva et al (42) reported the use of the VITOM Exoscope; KARL STORZ GmbH & Co., Tuttlingen, Germany) to generate pictures in assisting with the anatomic study of the cerebellar vascularization. Another anatomic study by Di Ieva et al (41) also used the exoscopic system to assist in the telovelar approach to access the fourth ventricle. The exoscope was used in an extradural macroscopic step to achieve greater image quality assisting the endoscopic procedure (41).…”

Section: Exoscopymentioning

confidence: 98%

“…Another anatomic study by Di Ieva et al (41) also used the exoscopic system to assist in the telovelar approach to access the fourth ventricle. The exoscope was used in an extradural macroscopic step to achieve greater image quality assisting the endoscopic procedure (41). With improvements in stereoscopic view and combined with robotic-assisted surgery (50,51), exoscopy has the potential to be widely practiced along with endoscopy in skull base surgery (e.g., exoscopeassisted microneurosurgery) and in the anatomic laboratory for surgical training ( Figure 13) (82).…”

Section: Exoscopymentioning

confidence: 98%

“…Exoscopy is a newly emerging technique for neurosurgery allowing visualization of the intracranial structures from outside of the body rather than inside, the way the endoscope does (41,42,50,51). Compared with the endoscope, the exoscope has been shown to provide a longer focal length and larger field of view, similar to an operating microscope.…”

Section: Exoscopymentioning

confidence: 99%

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A Journey into the Technical Evolution of Neuroendoscopy

et al. 2014

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“…Endoscopic telovelar approaches has also been tried in cadaveric models with some success. 3 Newer methods including neuromonitoring has helped in the safe removal of fourth ventricle tumors with minimum morbidity.…”

Section: 16mentioning

confidence: 99%

Telovelar Approach to IVth Ventricle Tumor: Experience and Review of Literature

Roka¹

2017

Nep J Neurosci

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P osterior fossa tumor surgery is challenging especially those located in the deeper regions of the middle and upper part of fourth ventricle. The traditional approach has been the vermis splitting or transcerebellar approach to gain access to these lesions. A major drawback of these approaches is the damage to the midline structures and development of cerebellar mutism. The newer approaches through the telovelar route Posterior fossa tumor surgery is challenging especially those located in the deeper regions of the middle and upper part of fourth ventricle. The traditional approach has been the vermis splitting or transcerebellar approach to gain access to these lesions. This is a retrospective study of all the cases operated via the telovelar approach between March 2008 and June 2017 in this centre. A total of eight cases were operated in this study period. With regards to medulloblastoma near total excision was achieved in 50% of the cases and one with total removal. Of these two cases needed postoperative ventriculo-peritoneal shunt , there were two cases of recurrence and in spite of cranio-spinal irradiation there were two deaths. Haemangioblastoma and choroid plexus papilloma were removed in total with no recurrence. One case of ependymoma had excessive bleeding with introperative hypotension leading to abandonment of the procedure. The telovelar approach has been described in detail by various authors elaborating the salient features along with the techniques to access the region around the fourth ventricle without the transvermian approach. The advantages of this approach are the avoidance of splitting the vermis and the theoretical reduced possibility of cerebellar mutism. Excision via bilateral telovelar approach have also been described for large tumors.Key Words: cerebellar mutism, ependymoma, medulloblastoma, posterior fossa, telovelar approach have been found to reduce these complications and also provide access to the deeper located lesions of the fourth ventricle. Materials and MethodsThis is a retrospective study of all the cases operated via the Telovelar approach between

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Endoscopic telovelar approach to the fourth ventricle: anatomic study

Cited by 26 publications

References 40 publications

The surgical treatment of tumors of the fourth ventricle: a single-institution experience

The surgical treatment of tumors of the fourth ventricle: a single-institution experience

A Journey into the Technical Evolution of Neuroendoscopy

Telovelar Approach to IVth Ventricle Tumor: Experience and Review of Literature

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