Microsurgical resection of the fourth ventricle tumors through the telovelar approach

Abstract

Objective To analyze the resection methods of the 4th ventricle tumor resection and clinical effect through the telovelar approach and to explore the opening portion of the tela choroidea and the inferior medullary velum based on the characteristics of tumors. Methods The clinical data of 21 patients in the Neurosurgery Department of Nanjing Brain Hospital from January 2013 to December 2016 who underwent resection of the 4th ventricle tumors through telovelar approach were retrospectively analyzed. Among them, unilateral approach was employed in 18 patients and bilateral approaches in 3 cases. Results Among the 21 patients, total resection was achieved in 17 cases and subtotal resection in 4 cases. The pathological results demonstrated the ependymoma in 12 cases, cavernoma in 3 cases, hemoblastoma in 2 cases, medulloblastoma in 2 cases and cholesteatoma in 2 cases. There was no death. The patients were followed up from 3 months to 2 years. The patients recovered well and had no long-term complications related to surgery. Conclusions The exposure of the 4th ventricle seems satisfactory through the telovelar approach without splitting the vermis. In most cases, the unilateral telovelar approach with merely the tela choroidea incision is adequate. That surgical procedure using the normal anatomical fissures could minimize brain injury and effectively prevent postoperative complications. Key words: Brain neoplasms; Fourth ventricle; Microsurgery; Telovelar approach