Endoscopic-Assisted Median Aperture Approach for Resection of Fourth Ventricular Tumor and Confirmation of Patency of Cerebral Aqueduct Using an Adjustable-Angle Endoscope: Technical Case Report

2017 ◽  
Vol 13 (2) ◽  
pp. 293-296 ◽  
Author(s):  
Ryan Austerman ◽  
Joshua Lucas ◽  
Alexandra Kammen ◽  
Gabriel Zada
Keyword(s):  
Case Report ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Technical Note ◽  
Cerebral Aqueduct ◽  
Suboccipital Craniotomy ◽  
Cerebellar Retraction ◽  
Telovelar Approach ◽  
Operative Microscope

Abstract BACKGROUND AND IMPORTANCE: Open microsurgical approaches to the roof of the fourth ventricle via a telovelar approach typically require cerebellar retraction and/or splitting of the vermis and may be associated with postoperative neurological morbidities. In this case report and technical note, we describe the use of an adjustable-angle endoscope inserted into the median aperture via suboccipital craniotomy, resulting in enhanced visualization of the roof of the fourth ventricle and cerebral aqueduct and maximal safe tumor resection. CLINICAL PRESENTATION: A 49-yr-old woman with obstructive hydrocephalus and a fourth ventricular mass that was not fully visible with the use of an operative microscope. CONCLUSION: Direct visualization of the roof of the fourth ventricle, including the superior medullary velum and cerebral aqueduct, can be facilitated with an adjustable angle endoscope inserted into the median aperture via suboccipital craniotomy to minimize the degree of telovelar dissection and vermis splitting.

scholarly journals Correction to: Iatrogenic obstructive hydrocephalus resulting from Gelfoam accumulation within the cerebral aqueduct: a case report

2019 ◽  
Vol 35 (6) ◽  
pp. 1089-1089
Author(s):  
Ali Hazama ◽  
Joseph Driver ◽  
Benjamin Grannan ◽  
Hurmozdiyar Dasenbrock ◽  
Liliana Goumnerova
Keyword(s):  
Case Report ◽  
Obstructive Hydrocephalus ◽  
Cerebral Aqueduct

scholarly journals Epidermoid Cyst of the IV Ventricle: Case Report

2017 ◽  
Vol 39 (01) ◽  
pp. 041-045
Author(s):  
Washington Clésio da Silva Ribeiro ◽  
Ricardo Macedo Camelo ◽  
Josias Inácio da Silva ◽  
Moana Vergetti Malta ◽  
Rafael Costa Camelo ◽  
...  
Keyword(s):  
Case Report ◽  
Epidermoid Cyst ◽  
Fourth Ventricle ◽  
Slow Growth ◽  
Obstructive Hydrocephalus ◽  
Intracranial Tumors ◽  
Pathological Anatomy ◽  
Cerebellar Syndrome ◽  
The Third ◽  
The Ideal

AbstractEpidermoid cysts constitute congenital, benign and rare lesions, corresponding to ∼ 0.2% to 1.8% of all intracranial tumors. Only 5% of the cases are located in the fourth ventricle. Despite their genesis in intrauterine life, they are usually diagnosed between the third and fifth decades of life due to their very slow growth pattern. The image weighted by the diffusion of the magnetic resonance is essential to establish the diagnosis. The ideal treatment consists of emptying the cystic content with complete capsule resection. In the present work, we report the case of a 31-year-old female with cerebellar syndrome that evolved with intracranial hypertension. The symptomatology was due to an obstructive hydrocephalus by an epidermoid cyst located inside the fourth ventricle, which was confirmed by the pathological anatomy.

Where the central canal begins: endoscopic in vivo description

2021 ◽  
pp. 1-10
Author(s):  
Pierluigi Longatti ◽  
Alessandro Fiorindi ◽  
Elisabetta Marton ◽  
Francesco Sala ◽  
Alberto Feletti
Keyword(s):  
Fourth Ventricle ◽  
Area Postrema ◽  
Obstructive Hydrocephalus ◽  
Indirect Evidence ◽  
Normal Pressure ◽  
Central Canal ◽  
Pathological Process ◽  
Cerebral Aqueduct ◽  
Anatomical Landmarks

OBJECTIVE Although evidence and descriptions of the central canal (CC) along the medulla oblongata and the spinal cord have been provided by several anatomical and radiological studies, a clear picture and assessment of the opening of the CC, or apertura canalis centralis (ACC), into the fourth ventricle is lacking, due to its submillimetric size and hidden position in the calamus scriptorius. METHODS The authors reviewed all of their cases in which patients underwent ventricular transaqueductal flexible endoscopic procedures and selected 44 cases in which an inspection of the region of the calamus scriptorius had been performed and was suitable for study inclusion. Patients were divided into different groups, based on the presence or absence of a chronic pathological process involving the fourth ventricle. In each case, the visual appearance of the opening of the CC of the ACC was classified as no evidence (A0), indirect evidence (A1), or clear evidence (A2). Morphometric measurements were inferred from surrounding structures and the size of surgical tools visible in the field. RESULTS The opening of the CC could be clearly observed in all cases (A1 4.5%, A2 95.5%). In normal cases, a lanceolate shape along the median sulcus was most frequently found, with an average size of 600 × 250 µm that became rounded and smaller in size in cases of hydrocephalus. The distance between the caudal margin of the ACC and the obex was about 1.8 mm in normal cases, 2.1 mm in cases of obstructive hydrocephalus, and 1 mm in cases of normal pressure hydrocephalus. The two wings of the area postrema, variable in size and shape, were sited just caudal to the opening. CONCLUSIONS A flexible scope inserted through the cerebral aqueduct can approach the hidden calamus scriptorius like a pen fits into an inkpot. With this privileged viewpoint, the authors provide for the first time, to their knowledge, a clear and novel vision of the opening of the CC in the fourth ventricle, along with the precise location of this tiny structure compared to other anatomical landmarks in the inferior triangle.

Combined Transventricular and Supracerebellar Infratentorial Approach Preserving the Vermis in Giant Pediatric Posterior Fossa Midline Tumors

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS30-ONS37 ◽  
Author(s):  
Elvis J. Hermann ◽  
Marion Rittierodt ◽  
Joachim K. Krauss
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Venous Drainage ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Low Grade ◽  
Suboccipital Craniotomy ◽  
Supracerebellar Infratentorial Approach

Abstract Objective: Giant pediatric midline tumors of the posterior fossa involving the fourth ventricle and the tectal region are difficult to approach and present a high risk of postoperative neurological deficits. Children with sequelae such as cerebellar mutism and ataxia experience a compromise in their quality of life. Here, we present our combined transventricular and supracerebellar infratentorial approach to avoid complications of vermian splitting. Methods: The combined transventricular and supracerebellar infratentorial approach described here was used in a total of four pediatric patients. A medial suboccipital craniotomy with opening of the foramen magnum and resection of the C1 lamina was performed with the patient in the semisitting position. The tumor mass filling the fourth ventricle was removed via a transventricular telovelar route through the foramen of Magendie, preserving the vermis. The rostral tumor portions in the peritectal region extruding up to the thalami were exposed and resected via an infratentorial supracere-bellar route to preserve the venous drainage of the cerebellum. Results: There were no new neurological deficits postoperatively. Two patients had low-grade astrocytomas, and two patients had malignant tumors. Complete tumor resection was achieved in two patients, and near-total tumor removal in the two others. CONCLUSION: The combined transventricular and supracerebellar infratentorial approach offers a unique possibility of safely removing giant pediatric midline tumors. Splitting of the cerebellar vermis is not necessary for removal of such tumors.

scholarly journals Primary Isolated Lymphoma of the Fourth Ventricle in an Immunocompetent Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Rakan Bokhari ◽  
Ahmad Ghanem ◽  
Mahmoud Alahwal ◽  
Saleh Baeesa
Keyword(s):  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Signs And Symptoms ◽  
Immunocompetent Patient ◽  
Third Ventriculostomy ◽  
Increased Intracranial Pressure ◽  
Complete Tumor Resection ◽  
Initial Line ◽  
Complete Tumor

Primary central nervous lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin's lymphoma with a especially poor prognosis. The diagnosis is usually encountered in immunodeficient patients but is also encountered, albeit uncommonly, in the immunocompetent. We present a 50-year-old male who developed signs and symptoms of increased intracranial pressure. Imaging revealed the presence of a fourth ventricle mass with obstructive hydrocephalus. First, the patient underwent emergency endoscopic third ventriculostomy followed, few days later, by complete tumor resection via a posterior fossa craniotomy. Postoperative histopathology revealed the lesion to be a PCNSL. He received adjuvant chemotherapy and radiation and remained with no recurrence on regular imaging studies for 18-month followup. We report herein the fourth case of isolated PCNSL lesion to the fourth ventricle in the literature and provide the rationale for our belief that craniotomy and tumor resection, if feasible, should be the initial line of management in similar cases to relieve hydrocephalus and achieve the diagnosis.

Management of a Persistent Oblique Occipital Sinus with Staged Ligation in a Case of Medulloblastoma: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Gaurav Tyagi ◽  
Gyani Jail Singh ◽  
Manish Beniwal ◽  
Dwarakanath Srinivas
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Female Child ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Outflow ◽  
Excessive Bleeding ◽  
Occipital Sinus ◽  
Suboccipital Craniotomy

<b><i>Introduction:</i></b> A patent persistent occipital sinus (OS) can be seen in 10% of adults. The presence of such a dominant draining OS can present as a challenge for posterior fossa surgeries. Occlusion or division of the sinus can cause venous hypertension, causing a cerebellar bulge or increased intra-op bleeding. <b><i>Case report:</i></b> A 3-and-a-half-year-old female child presented with a vermian medulloblastoma with hydrocephalus. MR venography (MRV) revealed a large patent OS draining from the torcula to the right sigmoid sinus. She underwent a left Frazier’s point VP shunt followed by a midline suboccipital craniotomy for the lesion. The OS was divided during a “Y”-shaped durotomy. Following the sinus ligation, there was a significant cerebellar bulge and excessive bleeding from the lesion. We released cisternal CSF and punctured the tumor cysts to allow the brain bulge to settle. Hemostasis was secured, and surgery was deferred, an augmented duroplasty was done, and bone flap was removed to allow for intracranial pressure decompression. The patient was electively ventilated for 24 h and weaned off gradually. A repeat MRV at 7 days showed the reorganization of the venous outflow at the torcula. Reexploration with tumor resection was done on post-op day 10. The patient recovered well from the surgery and was referred for adjuvant therapy. <b><i>Conclusion:</i></b> Surgeons should carefully analyze venous anatomy before posterior fossa surgeries. The persistent dominant OS, when present, should be taken care of while planning the durotomy. A hypoplastic but persistent transverse sinus allowed us to ligate and divide the OS. By doing a staged division of the sinus, reorganization of the venous outflow from the torcula can be allowed to occur, and the lesion can be resected.

scholarly journals Mandibular Setback as an Adjunctive Strategy for Reconstruction after Tumor Resection: A Technical Note and Case Report

2020 ◽  
Author(s):  
Hassan Mirmohammadsadeghi ◽  
Farzad Aghdashi ◽  
Golnaz Nahvi ◽  
Mohammad Esmaeelinejad
Keyword(s):  
Case Report ◽  
Success Rate ◽  
Surgical Procedures ◽  
Tumor Resection ◽  
Technical Note ◽  
Defect Size ◽  
Autogenous Bone ◽  
Bony Defect ◽  
Mandibular Setback ◽  
Grafting Procedure

Mandibular defects due to surgical resection of pathologies are common challenges for maxillofacial surgeons. In some clinical situations, alteration or combination of different surgical procedures is needed to reduce the size of bony defects and improve the success rate of bone grafts. In the current study, an 18-year-old female with a pathological lesion (ameloblastoma) in the mandible is presented. After tumor resection, bony defect reconstruction with autogenous bone graft was combined with a mandibular setback to facilitate the procedure. In this case, the simultaneous combination of orthognathic mandibular setback movement with tumor resection in a single surgical session helped to reduce the bony defect size. The adoption of this approach led to a decrease in the volume of graft harvesting and improved the success rate of the grafting procedure.

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