Resection of neoplasm in fourth ventricle through transtelovelar approach: a clinical study / 解放军医学杂志

ABSTRACT

Objective To study the advantages and procedure of telovelar approach for resection of the lesion in the fourth ventricle. Methods Telovelar approach to the fourth ventricle was executed in 17 cases. Among these patients, seven were females and 10 were males. The age ranged from 5 years to 49 years with mean age of 26.6 years. Pathologically, there were 5 medulloblastomas, 5 ependymomas, 2 epidermoids, 2 brain cysticercosis, and 3 choroid plexus papillomas. During the operation, the medullotonsillar space of the cerebellomedullary fissure and the urulotonsillar space were sharply dissected to release the tonsils from uvula and medullar oblongata bilaterally. According to the size of the neoplasm, the tela or both tela and velum were incised. The fourth ventricle was exposed adequately and the lesion was removed. All operations were performed with the help of microscope. The dura was sutured securely. Results The space occupying lesions were removed totally in all cases and all patients recovered very well, and threre was no mortality or serious disability. With 3 to 21-month follow-up in 11 cases, no death or serious disability was found, and the CT or MRI in 8 patients showed no recurrence. Conclusion The telovelar approach can provide adequate exposure to remove the lesion in the fourth venticle. The inferior vermis need not be incised, so a minimum amount of brain tissue was injured, and postoperative complication is decreased.