Foramen of Luschka

2020 ◽  
Author(s):  
Keyword(s):  
Foramen Of Luschka

Posterior Fossa Cyst and Hydrocephalus

2019 ◽  
pp. 239-245
Author(s):  
Peter J. Morone ◽  
John C. Wellons
Keyword(s):  
Posterior Fossa ◽  
Imaging Modality ◽  
Brain Mri ◽  
Mass Effect ◽  
Dandy Walker Malformation ◽  
Treatment Indications ◽  
Posterior Fossa Cyst ◽  
Walker Malformation ◽  
4Th Ventricle ◽  
Foramen Of Luschka

A Dandy-Walker malformation is an anatomical triad characterized by a large posterior fossa, agenesis of the cerebellar vermis, and dilation of the 4th ventricle. Up to 90% of patients will have hydrocephalus secondary to obstruction of fourth ventricular outflow through the foramen of Luschka and Magendie. The differential diagnosis of Dandy-Walker malformation includes Blake’s pouch cyst, a cystic structure originating within the roof of the 4th ventricle that herniates into the cisterna magna, and posterior fossa arachnoid cysts, which typically displace both the cerebellum and 4th ventricle anteriorly and demonstrate a propensity to enlarge. Brain MRI is the best diagnostic imaging modality to evaluate posterior fossa anatomy and cystic structures. Not all posterior fossa cysts require treatment. Indications for surgical intervention include enlargement, symptomatic mass effect and/or hydrocephalus.

Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation

2014 ◽  
Vol 121 (3) ◽  
pp. 723-729 ◽  
Author(s):  
Vivek R. Deshmukh ◽  
Leonardo Rangel-Castilla ◽  
Robert F. Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Case Series ◽  
Cavernous Malformations ◽  
Excellent Outcome ◽  
Suboccipital Craniotomy ◽  
Scale Scores ◽  
Far Lateral ◽  
Cerebellar Peduncle ◽  
Inferior Cerebellar Peduncle ◽  
Foramen Of Luschka

Object Brainstem cavernous malformations (BSCMs) present a unique therapeutic challenge to neurosurgeons. Resection of BSCMs is typically reserved for lesions that reach pial or ependymal surfaces. The current study investigates the lateral inferior cerebellar peduncle as a corridor to dorsolateral medullary BSCMs. Methods In this retrospective review, the authors present the cases of 4 patients (3 women and 1 man) who had a symptomatic dorsolateral cavernous malformation with radiographic and clinical evidence of hemorrhage. Results All patients underwent excision of the cavernous malformation via a far-lateral suboccipital craniotomy through the foramen of Luschka and with an incision in the inferior cerebellar peduncle. On intraoperative examination, 2 of the 4 patients had hemosiderin staining on the surface of the peduncle. All lesions were completely excised and all patients had a good or excellent outcome (modified Rankin Scale scores of 0 or 1). Conclusions This case series illustrates that intrinsic lesions of the dorsolateral medulla can be safely removed laterally through the foramen of Luschka and the inferior cerebellar peduncle.

Subtonsillar Approach to the Foramen of Luschka: An Anatomic and Clinical Study

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 860-866 ◽  
Author(s):  
Walter C. Jean ◽  
Khaled M. Abdel Aziz ◽  
Jeffrey T. Keller ◽  
Harry R. van Loveren
Keyword(s):  
Clinical Study ◽  
Cleavage Plane ◽  
Cerebellar Tonsil ◽  
Middle Cerebellar Peduncle ◽  
Suboccipital Craniotomy ◽  
Tela Choroidea ◽  
Cerebellomedullary Fissure ◽  
Lateral Decubitus ◽  
Cerebellar Peduncle ◽  
Foramen Of Luschka

Abstract OBJECTIVE Conventional approaches to tumors of the foramen of Luschka are limited because the foramen is viewed from either the fourth ventricle laterally (transvermian approach) or the cerebellopontine angle medially (suboccipital approach). The definitive approach is subtonsillar, because the foramen of Luschka is actually the end of the natural cleavage plane between the cerebellar tonsil and the medulla. We describe the microsurgical anatomic features of the foramen of Luschka region and the operative technique for the subtonsillar approach to this region. METHODS In the anatomic study, five formalin-fixed, silicone-injected, cadaveric heads were used. In the clinical study, the records for five patients treated via the subtonsillar approach were examined; several illustrative cases are presented. RESULTS The foramen of Luschka is formed by the tela choroidea and the rhomboid lip and exists at the lateral end of the cerebellomedullary fissure, which is a natural cleavage plane between the cerebellar tonsil and the medulla. The subtonsillar approach is performed via a suboccipital craniotomy; the patient is positioned in the lateral decubitus position, with the tumor side down. After the cerebellar tonsil is freed from arachnoid adhesions, it can be retracted rostrodorsally from the medulla, to expose the cerebellomedullary fissure. Clinically, the tela choroidea and rhomboid lip are significantly attenuated by tumor expansion. Therefore, by dissecting in a subtonsillar manner around the tumor, one can reach the foramen of Luschka without traversing any neural tissue. CONCLUSION The subtonsillar approach yields a panoramic view to the foramen of Luschka laterally and up to the middle cerebellar peduncle superiorly. This approach minimizes the distance between the tumor and the surgeon, while maximizing neural preservation. We think this is the definitive approach to this difficult region of the posterior fossa.

Three-Dimensional Computational Modeling of Subject-Specific Cerebrospinal Fluid Flow in the Subarachnoid Space

2008 ◽  
Vol 131 (2) ◽  
Author(s):  
Sumeet Gupta ◽  
Michaela Soellinger ◽  
Peter Boesiger ◽  
Dimos Poulikakos ◽  
Vartan Kurtcuoglu
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Three Dimensional ◽  
Volumetric Flow Rate ◽  
Cerebrospinal Fluid Flow ◽  
Spinal Subarachnoid Space ◽  
Subject Specific ◽  
Foramen Of Luschka

This study aims at investigating three-dimensional subject-specific cerebrospinal fluid (CSF) dynamics in the inferior cranial space, the superior spinal subarachnoid space (SAS), and the fourth cerebral ventricle using a combination of a finite-volume computational fluid dynamics (CFD) approach and magnetic resonance imaging (MRI) experiments. An anatomically accurate 3D model of the entire SAS of a healthy volunteer was reconstructed from high resolution T2 weighted MRI data. Subject-specific pulsatile velocity boundary conditions were imposed at planes in the pontine cistern, cerebellomedullary cistern, and in the spinal subarachnoid space. Velocimetric MRI was used to measure the velocity field at these boundaries. A constant pressure boundary condition was imposed at the interface between the aqueduct of Sylvius and the fourth ventricle. The morphology of the SAS with its complex trabecula structures was taken into account through a novel porous media model with anisotropic permeability. The governing equations were solved using finite-volume CFD. We observed a total pressure variation from −42Pato40Pa within one cardiac cycle in the investigated domain. Maximum CSF velocities of about 15cm∕s occurred in the inferior section of the aqueduct, 14cm∕s in the left foramen of Luschka, and 9cm∕s in the foramen of Magendie. Flow velocities in the right foramen of Luschka were found to be significantly lower than in the left, indicating three-dimensional brain asymmetries. The flow in the cerebellomedullary cistern was found to be relatively diffusive with a peak Reynolds number (Re)=72, while the flow in the pontine cistern was primarily convective with a peak Re=386. The net volumetric flow rate in the spinal canal was found to be negligible despite CSF oscillation with substantial amplitude with a maximum volumetric flow rate of 109ml∕min. The observed transient flow patterns indicate a compliant behavior of the cranial subarachnoid space. Still, the estimated deformations were small owing to the large parenchymal surface. We have integrated anatomic and velocimetric MRI data with computational fluid dynamics incorporating the porous SAS morphology for the subject-specific reconstruction of cerebrospinal fluid flow in the subarachnoid space. This model can be used as a basis for the development of computational tools, e.g., for the optimization of intrathecal drug delivery and computer-aided evaluation of cerebral pathologies such as syrinx development in syringomelia.

Posterior Fossa Ependymoma

2019 ◽  
pp. 223-230
Author(s):  
Frederick A. Boop ◽  
Jimmy Ming-Jung Chuang
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Standard Of Care ◽  
Extent Of Resection ◽  
Clinical Findings ◽  
Current Standard ◽  
Subarachnoid Spaces ◽  
Growth Of Tumor ◽  
Foramen Of Luschka

Pediatric posterior fossa ependymomas are typically well-delineated masses with heterogenous enhancement arising from the floor, lateral aspect, or roof of the fourth ventricle. Growth of tumor into the posterior fossa subarachnoid spaces, particularly into the foramen of Magendie and the cerebellopontine angles via the foramen of Luschka, is a radiological hallmark of this tumor. Clinical findings of elevated intracranial pressure and obstructive hydrocephalus are common at presentation. The current standard of care for children with ependymoma consists of gross total resection with subsequent focal radiotherapy. The extent of resection is the single most important determinant of outcome. Hydrocephalus typically resolves after resection, and it is uncommon to require cerebrospinal shunt placement after tumor removal.

Comparison of the transvermian and telovelar approaches to the fourth ventricle

2004 ◽  
Vol 101 (3) ◽  
pp. 484-498 ◽  
Author(s):  
Necmettin Tanriover ◽  
Arthur J. Ulm ◽  
Albert L. Rhoton ◽  
Alexandre Yasuda
Keyword(s):  
Fourth Ventricle ◽  
Image Guidance ◽  
Surgical Approaches ◽  
Content Type ◽  
Lateral Recess ◽  
Telovelar Approach ◽  
Additional Exposure ◽  
Formalin Fixed ◽  
Fine Print ◽  
Foramen Of Luschka

Object. The two most common surgical routes to the fourth ventricle are the transvermian and telovelar approaches. The purpose of this study was to compare the microanatomy and exposures gained through these approaches. Methods. Ten formalin-fixed specimens were dissected in a stepwise manner to simulate the transvermian and telovelar surgical approaches. Stealth image guidance was used to compare the exposures and working angles obtained using these approaches. The transvermian and telovelar approaches provided access to the entire rostrocaudal length of the fourth ventricle floor from the aqueduct to the obex. In addition, both approaches provided access to the entire width of the floor of the fourth ventricle. The major difference between the two approaches regarded the exposure of the lateral recess and the foramen of Luschka. The telovelar, but not the transvermian, approach exposed the lateral and superolateral recesses and the foramen of Luschka. The transvermian approach, which offered an incision through at least the lower third of the vermis, afforded a modest increase in the operator's working angle compared with the telovelar approach when accessing the rostral half of the fourth ventricle. Conclusions. The transvermian approach provides slightly better visualization of the medial part of the superior half of the roof of the fourth ventricle. The telovelar approach, which lacks incision of any part of the cerebellum, provides an additional exposure to the lateral recesses and the foramen of Luschka.

scholarly journals Combined telovelar-minimal transvermian approach for a bleeding pontine cavernoma in a 48-year-old patient – case report and literature review

2018 ◽  
Vol 32 (2) ◽  
pp. 205-210
Author(s):  
R. Radu ◽  
G. Petrescu ◽  
C. Gorgan ◽  
C. Cristescu ◽  
F. M. Brehar ◽  
...  
Keyword(s):  
Case Report ◽  
Recurrent Bleeding ◽  
Anatomical Location ◽  
Patient Case ◽  
Cavernous Malformations ◽  
Minimal Incision ◽  
Telovelar Approach ◽  
Permanent Neurological Deficit ◽  
Good Access ◽  
Foramen Of Luschka

Abstract Symptomatic pontine cavernous malformations carry a high risk of recurrent bleeding, which may result in permanent neurological deficit. Such lesions require surgical management that can be challenging to the neurosurgeon due to their anatomical location and their proximity to delicate neural structures. An ideal surgical approach should provide maximal surgical resection with minimal morbidity. We present the case of a 48-year-old woman with a pontine cavernoma with repeated spontaneous intralesional hemorrhages, resected using a telovelar approach extended by a minimal incision of the inferior vermis, with good surgical outcome. The telovelar approach provided a good access to the lateral recesses and the foramen of Luschka, while the lower vermian incision provided a greater vertical working angle inside the ventricle.

Diverticular Enlargement of Foramen of Luschka and Hydrocephalus in Child with Noonan Syndrome

2019 ◽  
Vol 125 ◽  
pp. 371-373 ◽  
Author(s):  
Pietro Spennato ◽  
Matteo Sacco ◽  
Giuseppe Cinalli
Keyword(s):  
Noonan Syndrome ◽  
Foramen Of Luschka
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