Telovelar approach versus transvermian approach in management of fourth ventricular tumors

Ebrahim, Khaled Saeed; Toubar, Ahmed Faisal

doi:10.1186/s41984-019-0036-9

Cited by 10 publications

(12 citation statements)

References 17 publications

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“…Over the last decades, further authors have proposed technically advantaged approaches to the ventricular system. Regarding the fourth ventricle, approaches as the transvermian [ 9 ], a subtonsillar-transcerebellomedullary [ 10 ], a superior transvelar approach [ 11 ] or also endoscopic approaches [ 12 , 13 ] were described with claiming to be the superior one. The transvermian approach has been performed frequently in history, but data showed high rates of cerebellar mutism and disequilibrium [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature

et al. 2020

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Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009–05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results Forty five IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.

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Section: Introductionmentioning

confidence: 99%

Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature

et al. 2020

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“…When the telovelar approach is compared with the transvermian approach (33,34), it seems to be protective for postoperative CM and neurological morbidity, although statistical significance was only reported by Ferguson et al (33) in a mixed adult/child series. The work of Ebrahim et al (34) does not include adequate statistical analysis.…”

Section: Discussionmentioning

confidence: 93%

“…Many surgical series, focused exclusively on the telovelar approach, show the beneficial result of this approach in preventing or reducing CM ( 15 – 24 , 32 ). When the telovelar approach is compared with the transvermian approach ( 33 , 34 ), it seems to be protective for postoperative CM and neurological morbidity, although statistical significance was only reported by Ferguson et al. ( 33 ) in a mixed adult/child series.…”

Section: Discussionmentioning

confidence: 96%

The Clinical and Prognostic Impact of the Choice of Surgical Approach to Fourth Ventricular Tumors in a Single-Center, Single-Surgeon Cohort of 92 Consecutive Pediatric Patients

et al. 2022

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ObjectiveA single-institution cohort of 92 consecutive pediatric patients harboring tumors involving the fourth ventricle, surgically treated via the telovelar or transvermian approach, was retrospectively reviewed in order to analyze the impact of surgical route on surgery-related outcomes and cumulative survival.MethodsClinical, radiological, surgical, and pathology details were retrospectively analyzed. We selected n = 6 surgery-related clinical and radiological outcomes: transient and permanent neurological deficits, duration of assisted ventilation, postoperative new onset medical events, postoperative cerebellar mutism, and extent of resection. We built univariate and multivariate logistic models to analyze the significance of relationships between the surgical routes and the outcomes. Cumulative survival (CS) was estimated by the cohort approach.ResultsThere were 53 girls and 39 boys (mean age, 83 months). Telovelar approach was performed in 51 cases and transvermian approach in 41 cases. Early postoperative MRI studies showed complete removal in 57 cases (62%) and measurable residual tumor in 35 cases (38%). The average tumor residual volume was 1,316 cm3 (range, 0.016–4.231 cm3; median value, 0.9875 cm3). Residual disease was more often detected on immediate postop MRI after telovelar approach, but the difference was not significant. Cerebellar mutism was observed in 10 cases (11%). No significant difference in the onset of cerebellar mutism was detected between telovelar and transvermian approach. The choice of surgical approach did not significantly modify any other postoperative outcome and 1-/3-year CS of high-grade surgically treated tumors.ConclusionsWith the limitation of a single-center, single-surgeon retrospective series, our findings offer significant data to reconsider the real impact of the choice of the surgical route to the fourth ventricle on the incidence of cerebellar mutism and surgery-related morbidity. This seems to be in line with some recent reports in the literature. Surgical approach to the fourth ventricle should be individualized according to the location of the tumor, degree of vermian infiltration, and lateral and upward extension. Telovelar and transvermian approaches should not be considered alternative but complementary. Pediatric neurosurgeons should fully master both approaches and choose the one that they consider the best for the patient based on a thorough and careful evaluation of pre-operative imaging.

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“…In a study of 40 patients presenting with various fourth ventricular masses with a 1:1 distribution of telovelar vs. transvermian resection, 75% of telovelar cases and 60% of transvermian cases achieved GTR. In addition, postoperative complications were higher with the transvermian approach, most notably cerebellar mutism and bulbar palsy, each with an incidence of 15% in transvermian and no incidence in telovelar cases [ 6 ]. The telovelar approach is currently preferred over the transvermian approach, which has a higher risk of cerebellar mutism.…”

Section: Discussionmentioning

confidence: 99%

Atypical Choroid Plexus Papilloma of the Fourth Ventricle in an Adult: A Case Report

Goel¹,

Birdi²,

Menaker³

et al. 2022

Cureus

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Atypical choroid plexus papilloma (aCPP) is very rarely seen in adults. Here, we present the case of a 47-year-old male with several months of headache, nausea, dizziness, and imbalance who was found to have an enhancing mass of the fourth ventricle with imaging findings suggestive of likely ependymoma. The patient underwent suboccipital craniotomy with C1 laminectomy and telovelar approach for gross-total resection of the lesion, with final pathology demonstrating WHO grade II aCPP. Subsequent genomic analysis showed a biologically relevant TERT mutation, as well as several variants of unknown significance. We conclude that aCPP is a rare, benign entity diagnosed by tissue sample that is potentially curative with surgical resection and may harbor targetable genetic mutations.

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Telovelar approach versus transvermian approach in management of fourth ventricular tumors

Cited by 10 publications

References 17 publications

Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature

Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature

The Clinical and Prognostic Impact of the Choice of Surgical Approach to Fourth Ventricular Tumors in a Single-Center, Single-Surgeon Cohort of 92 Consecutive Pediatric Patients

Atypical Choroid Plexus Papilloma of the Fourth Ventricle in an Adult: A Case Report

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