Telovelar Approach to Fourth Ventricle Tumors: Highlights and Limitations

Tomasello, Francesco; Conti, Alfredo; Cardali, Salvatore; Torre, Domenico La; Angileri, Filippo Flavio

doi:10.1016/j.wneu.2015.01.039

Cited by 60 publications

(71 citation statements)

References 19 publications

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“…The highest percentage of total tumor excision was seen in choroid plexus papillomas, followed by medulloblastomas, and then ependymomas. These results were concurring with the results published by El-Bahy, Gok et al, and Tomasello et al They had percentage of total excision in 69%, 86%, and 89% respectively [9,11,12]. (These numbers include our total and near total excisions added together).…”

Section: Discussionsupporting

confidence: 92%

“…This was also the same cause of mortalities in the studies published by Tomasello et al and Hans [12,13].…”

Section: Discussionsupporting

confidence: 65%

“…This low incidence of cerebellar mutism was also noticed in most published series concerning this issue. El-Bahy [11] and Tomasello et al [12] didn't have any cases of cerebellar mutism, while Hans et al [13] had incidence of 8%.…”

Section: Discussionmentioning

confidence: 99%

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Telovelar Approach for Midline Posterior Fossa Tumors in Paediatrics: 25 Cases Experience

Refaat¹,

Elrefaee²,

Elhalaby³

2016

J Neurol Disord

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Background: The classic transvermian route for excision of fourth ventricular tumors could be associated with postoperative cerebellar mutism. The Telovelar approach leads to the fourth ventricle via the cerebellomedullary fissure, avoiding retraction on the dentate nuclei and vermian incisions, hence lowering the incidence of cerebellar mutism. Objective: The aim of this study is to evaluate the Telovelar approach for excision of fourth ventricular tumors.

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Section: Discussionsupporting

confidence: 92%

“…This was also the same cause of mortalities in the studies published by Tomasello et al and Hans [12,13].…”

Section: Discussionsupporting

confidence: 65%

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Telovelar Approach for Midline Posterior Fossa Tumors in Paediatrics: 25 Cases Experience

Refaat¹,

Elrefaee²,

Elhalaby³

2016

J Neurol Disord

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“…Generally, we had no problem with tumor size or location in the superior part of the ventricle. GTR was 88.9% in Tomasello et al's case series (25,26), and 82.0% in Han et al's series (10).…”

Section: █ Discussionmentioning

confidence: 80%

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

Atallah¹,

Rady²,

Kamal³

et al. 2018

Turkish Neurosurgery

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The telovelar approach can be used as the standard approach for almost all fourth ventricle lesions. However, to date, the clinical series reporting on the pros and cons of this approach do not provide sufficient data to adequately evaluate the outcome (26). █ MATERIAL and METHODS This prospective study included 44 male and female patients with newly diagnosed fourth ventricular tumor treated at █ INTRODUCTION I ts direct relation to the brainstem and deep location anterior and ventral of the cerebellum make access to the fourth ventricle challenging (24). The transvermian approach to the fourth ventricle with splitting of the inferior vermis may result in caudal vermis syndrome, cerebellar mutism, or injury of the dentate nuclei resulting in head nodding, truncal ataxia, and nystagmus (2,11,21,30). AIM: To describe our institution's experience with the telovelar approach as well as factors governing radicality and outcome for pediatric fourth ventricle tumors. MATERIAL and METHODS: During March 2015-January 2017, 44 children with fourth ventricular tumors were operated using the telovelar approach. Radicality, neurological outcome, complications, and survival rates were evaluated. Statistical analysis was performed to determine factors associated with radicality and neurological outcome. RESULTS: Gross tumor removal was achieved in 37 patients (84.1%). All patients required cerebrospinal fluid (CSF) diversion through a ventriculoperitoneal shunt. Six patients (13.6%) developed cerebellar mutism, 4 patients (9.1%) developed bulbar paralysis (lower cranial nerve palsy), and 13 patients (30.2%) had tumor recurrence. Medulloblastoma was associated with the highest risk of cerebellar mutism (p=0.040). A poor prognosis (according to overall and progression-free survival rates) was associated with subtotal resection (p=0.020), large cell/anaplastic medulloblastoma and anaplastic ependymoma (p=0.038), highrisk medulloblastoma (p=0.005), and CSF seeding (p<0.001). CONCLUSION: The telovelar approach provides an adequate anatomical exposure of the fourth ventricle and allows early visualization and protection of its floor (brainstem). It facilitates adequate radicality and is associated with a lower incidence of cerebellar mutism and other approach-related complications. The working angle, particularly to the rostral part of the fourth ventricle, can be increased by removing the posterior arch of the atlas.

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“…The limitations are the superior end of the tumour which may not be accessible in some cases as pointed out by other authors too. 18,19 Although total removal is the aim and is possible even in large tumours, it should not be done at the cost of any neurological defi cits.…”

mentioning

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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Telovelar Approach to Fourth Ventricle Tumors: Highlights and Limitations

Cited by 60 publications

References 19 publications

Telovelar Approach for Midline Posterior Fossa Tumors in Paediatrics: 25 Cases Experience

Telovelar Approach for Midline Posterior Fossa Tumors in Paediatrics: 25 Cases Experience

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

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

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