Experiences with the Telovelar Approach to Fourth Ventricular Tumors in Children

Background: Fourth ventricular tumors are amongst the most common tumors in the pediatric population. Traditionally, these tumors are approached through the cerebellar vermis, but the telovelar approach is now becoming widespread. Posterior fossa syndrome/cerebellar mutism is a complication of surge...

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Vydáno v:	Pediatric neurosurgery Ročník 46; číslo 5; s. 340 - 343
Hlavní autoři:	Zaheer, S. Noman, Wood, Martin
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Basel, Switzerland S. Karger AG 01.01.2010
Témata:	Adolescent Cerebellum - diagnostic imaging Cerebellum - surgery Cerebral Ventricle Neoplasms - diagnostic imaging Cerebral Ventricle Neoplasms - surgery Child Child, Preschool Female Fourth Ventricle - diagnostic imaging Fourth Ventricle - surgery Humans Infant Male Mutism - diagnostic imaging Mutism - etiology Mutism - prevention & control Neurosurgery Neurosurgical Procedures - adverse effects Neurosurgical Procedures - methods Original Paper Pediatrics Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Postoperative Complications - prevention & control Prospective Studies Radiography Tumors Telovelar approach Fourth ventricular tumor, children
ISSN:	1016-2291, 1423-0305, 1423-0305
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Shrnutí:	Background: Fourth ventricular tumors are amongst the most common tumors in the pediatric population. Traditionally, these tumors are approached through the cerebellar vermis, but the telovelar approach is now becoming widespread. Posterior fossa syndrome/cerebellar mutism is a complication of surgery for fourth ventricular tumors whose precise cause remains elusive, but may be related to the surgical approach or injury to adjacent cerebellar structures. We present a small series of fourth ventricular tumors and our initial experience in using the telovelar approach for this surgery. Methods: Twenty patients with fourth ventricular tumors were operated on using the microsurgical telovelar approach, sparing the cerebellar vermis. Data were collected prospectively for all patients with respect to the degree of resection achieved, complications and the incidence of posterior fossa syndrome. Results: A complete resection was achieved on postoperative MRI in 70% of the patients. Residual disease <1.5 cm 3 remained in 15% and a further 15% had subtotal resection with >1.5 cm 3 of residual disease. Thirty percent had evidence of posterior fossa syndrome in the postoperative period, of which 84% had resolved at the last follow-up. Thirty percent of the patients developed symptomatic hydrocephalus requiring shunting. There were no new neurological deficits and no procedure-related deaths. Conclusion: The telovelar approach provides excellent access to tumors of the fourth ventricle with sparing of the vermis in children. The high incidence of cerebellar mutism in our patients confirms that this phenomenon is unlikely to be related to vermian injury and further study is recommended.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 14 content type line 23
ISSN:	1016-2291 1423-0305 1423-0305
DOI:	10.1159/000321539