Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus

Shimoji, Koki; Miyajima, Masakazu; Karagiozov, Kostadin; Yatomi, Kenji; Matsushima, Toshio; Arai, Hajime

doi:10.1007/s00381-009-0835-5

Cited by 24 publications

(13 citation statements)

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“…The traditional approach for removing ependymomas of the fourth ventricle is incision of the cerebellar vermis, which, however, is often associated with a higher incidence of cerebellar mutism or posterior fossa syndrome, along with chronic neurocognitive sequelae, compared with the trans-CMF appr oach (13,(18)(19)(20)(21)24,25,(41)(42)(43). The trans-CMF approach to the fourth ventricle, which does not cause significant injury to the neural tissue, was first proposed by Matsushima et al (36), and is currently widely accepted (8,13,14,(18)(19)(20)(22)(23)(24)(25)(26)(29)(30)(31)(32)36,43).…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of ependymomas is more common in pediatric patients than in adult patients, accounting for 8-13% of all intracranial tumors in children and up to 4% of brain tumors in adults. Approximately one-half of ependymomas are found in children aged <3 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In children, ependymomas usually occur in the fourth ventricle and display a series of symptoms and signs, including increased intracranial pressure, ataxia, vertigo, chronic cerebellar tonsillar hernia and brainstem dysfunction (1,14).…”

Section: Introductionmentioning

confidence: 99%

“…Ependymomas of the fourth ventricle are usually approached with a posterior median craniotomy/craniectomy, followed by splitting of the vermis; however, this trans-vermian approach could easily injure the vermis, cerebellar dentate and globose nuclei, which may result in tremor, ataxia, atonia and cerebellar mutism, thereby affecting the prognosis (13,14,(18)(19)(20)(21)(22)(23)(24)(25). The establishment of the novel trans-cerebellomedullary fissure (CMF) approach, which provides sufficient access to the fourth ventricle without sacrificing the inferior vermis, has been associated with favorable outcomes (13,14,(18)(19)(20)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: Introductionmentioning

confidence: 99%

“…The establishment of the novel trans-cerebellomedullary fissure (CMF) approach, which provides sufficient access to the fourth ventricle without sacrificing the inferior vermis, has been associated with favorable outcomes (13,14,(18)(19)(20)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The trans-CMF approach is gaining popularity among the available surgical approaches that are used for the complete removal of fourth ventricular tumors excessively extending laterally into the cerebellomedullary cistern ( children, ependymomas of the fourth ventricle usually originate from the ependymal layer and are well-circumscribed (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…in the 12 patients with supratentorial ventricular enlargement, 3 patients with hydrocephalus received frontal ventriculostomy 2 or 3 days prior to tumor removal, and the other 9 patients underwent occipital ventriculostomy intraoperatively, prior to dural incision. As previously described (13,14,(18)(19)(20)23,30), all patients were operated on in the prone position with the head flexed at the craniocervical junction. A vertical midline incision was performed, followed by a suboccipital craniotomy/craniectomy, with a bone window of ~5.0x4.0 cm.…”

Section: Introductionmentioning

confidence: 99%

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Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: A review of 26 cases

Qiu

Wang

et al. 2016

Oncology Letters

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Abstract. In the present study, the microsurgical management of 26 ependymomas of the fourth ventricle in children via the trans-cerebellomedullary fissure (CMF) approach was reviewed and evaluated. Clinical data were obtained from 26 ependymomas of the fourth ventricle treated with microsurgery using the trans-CMF approach from March 2006 to September 2010 at the Department of Neurosurgery of The First Affiliated Hospital of China Medical University (Shenyang, China). These data were collected and analyzed. Suboccipital median posterior fossa craniotomy and trans-CMF approach were performed in all cases for the microsurgical removal of the tumors. An additional incision was performed in the inferior medullary velum of 5 patients, in order to obtain adequate exposure of the tumors. As a result, all tumors were well exposed during surgery. Gross total resection (GTR) was achieved in 22 cases, near total resection (NTR) in 3 cases and subtotal resection (STR) in 1 case. All excised tumors were pathologically confirmed. No mortality occurred intraoperatively, and no patient presented with mutism or any other surgery-related complications. One patient suffered from postoperative hydrocephalus and received ventriculoperitoneal shunting, which relieved the symptoms. Over the 3.0-7.5-year follow-up period (mean, 4.8 years), tumor relapse occurred in 1 case with GTR, 2 cases with NTR and 1 case with STR. In total, 3 patients succumbed to tumor relapse and 4 were lost to follow-up. According to the literature and the clinical experience of the present authors, the trans-CMF approach provides safe and sufficient access to the fourth ventricle without the requirement of an incision in the inferior vermis. This approach prevents damage to the normal cerebellum and improves the surgical outcome. Tumor removal, restoration of cerebrospinal fluid circulation and preservation of brainstem function are factors that should be taken into consideration during surgery. For patients with residual tumors, adjuvant radiotherapy and/or chemotherapy may be beneficial.

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