scholarly journals Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: A review of 26 cases

2016 ◽  
Vol 11 (6) ◽  
pp. 4099-4106 ◽  
Author(s):  
BO QIU ◽  
YONG WANG ◽  
WEI WANG ◽  
CHAO WANG ◽  
PENGFEI WU ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Cerebellomedullary Fissure

Surgical approach to the fourth ventricle cavity through the cerebellomedullary fissure

2004 ◽  
Vol 27 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Abdulvahap G�k ◽  
Mehmet Alptekin ◽  
Ibrahim Erkutlu
Keyword(s):  
Surgical Approach ◽  
Fourth Ventricle ◽  
Cerebellomedullary Fissure

Telovelar approach for microsurgical resection of fourth ventricular subependymoma arising from rhomboid fossa: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V5
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Fourth Ventricle ◽  
Total Resection ◽  
Tela Choroidea ◽  
Safe Technique ◽  
Microsurgical Resection ◽  
Cerebellomedullary Fissure ◽  
Telovelar Approach ◽  
Ventricular Tumors ◽  
Rhomboid Fossa ◽  
Neurologically Intact

Fourth ventricular tumors have traditionally been removed via transvermian approaches, which can result in potential dysequilibrium and mutism. The telovelar approach is an excellent alternative to widely expose fourth ventricular tumors without transgressing the cerebellar vermis. This is achieved by opening the cerebellomedullary fissure and incising the tela choroidea and inferior medullary velum, which form the lower half of the roof of the fourth ventricle. In this operative video manuscript, the authors demonstrate microsurgical resection of a fourth ventricular subependymoma arising from the rhomboid fossa via the telovelar approach. The key technical nuance in this video is to demonstrate a gentle and safe technique to identify a dissectable plane to peel the tumor off of the rhomboid fossa using a microspreading technique with fine micro-bayonetted forceps. A gross-total resection was achieved, and the patient was neurologically intact.The video can be found here: https://youtu.be/ZEHHbUGb9zk.

Microsurgery of the Fourth Ventricle: Part 1

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 631-667 ◽  
Author(s):  
Toshio Matsushima ◽  
Albert L. Rhoton ◽  
Carla Lenkey
Keyword(s):  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Tela Choroidea ◽  
Cerebellar Peduncles ◽  
Cerebellomedullary Fissure ◽  
Relationship Of ◽  
The Relationship ◽  
Arteries And Veins ◽  
The Brain ◽  
4Th Ventricle

Abstract Operations on the 4th ventricle offer the potential for injury of the brain stem, cerebellum, cranial nerves, and major cerebellar arteries and veins. Twenty-five cadaver brains were examined using 3× to 25× magnification to define the relationship of these vital structures to the 4th ventricle. The 4th ventricle has a roof, a floor, and two lateral recesses. Most of the cranial nerves arise near the floor, which sits on the pons and medulla. The superior half of the roof, formed by the superior medullary velum, lingula, and cerebellar peduncles, is intimately related to the cerebellomesencephalic fissure, the superior cerebellar arteries, and the vein of the cerebellomesencephalic fissure. The inferior half of the roof, formed by the inferior medullary velum, tela choroidea, nodule, and uvula, is intimately related to the cerebellomedullary fissure, the posterior inferior cerebellar arteries, and the veins of the cerebellomedullary fissure. The lateral recesses and adjoining parts of the roof and floor are intimately related to the cerebellopontine fissures, the anterior inferior cerebellar arteries, and the veins of the cerebellopontine fissure. The cerebellar peduncles converge on and form a major part of the ventricular surface. The hili of the dentate nuclei abut on the superolateral recesses of the ventricle near the superior poles of the tonsils.

scholarly journals Suboccipital craniectomy with bilateral cerebellomedullary fissure dissection for resection of a ruptured tonsillar/vermian AVM occupying the roof of the fourth ventricle in a pregnant patient

2021 ◽  
Vol 4 (1) ◽  
pp. V6
Author(s):  
Daniel M. S. Raper ◽  
Kunal P. Raygor ◽  
Caleb Rutledge ◽  
Todd B. Dubnicoff ◽  
Adib A. Abla
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Posterior Inferior Cerebellar Artery ◽  
Pregnant Patient ◽  
Posterior Fossa Decompression ◽  
Suboccipital Craniotomy ◽  
Suboccipital Craniectomy ◽  
Human Research Protection Program ◽  
Cerebellomedullary Fissure

Posterior fossa arteriovenous malformations (AVMs) in pregnant patients can present unique considerations for surgical treatment, including positioning to minimize pressure on the fetus, minimization of radiation exposure, and ethical considerations regarding emergency surgery. This video outlines surgical treatment of a ruptured tonsillar/vermian AVM performed in a staged fashion after emergent suboccipital craniotomy with posterior fossa decompression in the setting of a life-threatening infratentorial hemorrhage. Later, bilateral cerebellomedullary fissure dissection, exposure and dissection of the tela choroidea and inferior medullary velum, and disconnection of arterial feeders from the posterior inferior cerebellar artery (PICA) allowed resection of this AVM occupying the roof of the fourth ventricle.This study was approved by the UCSF Human Research Protection Program IRB no. 18-26938.The video can be found here: https://youtu.be/rTYUGanopUEhttps://thejns.org/doi/abs/10.3171/2020.10.FOCVID2059

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