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Watanabe G, Conching A, Fry L, Putzler D, Khan MF, Haider MA, Haider AS, Ferini G, Rodriguez-Beato FY, Sharma M, Umana GE, Palmisciano P. Intraventricular Glioma in Pediatric Patients: A Systematic Review of Demographics, Clinical Characteristics, and Outcomes. World Neurosurg 2024; 186:252-262.e10. [PMID: 38608813 DOI: 10.1016/j.wneu.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE We conducted a systematic review on pediatric intraventricular gliomas to survey the patient population, tumor characteristics, management, and outcomes. METHODS PubMed, Scopus, Web-of-Science, and Cochrane were searched using PRISMA guidelines to include studies reporting pediatric patients with intraventricular gliomas. RESULTS A total of 30 studies with 317 patients were included. Most patients were male (54%), diagnosed at a mean age of 8 years (0.2-19), and frequently exhibited headache (24%), nausea and vomiting (21%), and seizures (15%). Tumors were predominantly located in the fourth (48%) or lateral ventricle (44%). Most tumors were WHO grade 1 (68%). Glioblastomas were rarely reported (2%). Management included surgical resection (97%), radiotherapy (27%), chemotherapy (8%), and cerebrospinal fluid diversion for hydrocephalus (38%). Gross total resection was achieved in 59% of cases. Cranial nerve deficit was the most common postsurgical complication (28%) but most were reported in articles published prior to the year 2000 (89%). Newer cases published during or after the year 2000 exhibited significantly higher rates of gross total resection (78% vs. 39%, P < 0.01), lower rates of recurrence (26% vs. 47%, P < 0.01), longer average overall survival time (42 vs. 21 months, P = 0.02), and a higher proportion of patients alive (83% vs. 70%, P = 0.03) than in older cases. CONCLUSIONS Pediatric intraventricular gliomas correlate with parenchymal pediatric gliomas in terms of age at diagnosis and general outcomes. The mainstay of management is complete surgical excision and more recent studies report longer overall survival rates and less cranial nerve complications.
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Affiliation(s)
- Gina Watanabe
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA.
| | - Andie Conching
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Dillon Putzler
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | | | | | - Ali S Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | | | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
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Hanaei S, Maroufi SF, Sadeghmousavi S, Nejati A, Paeinmahalli A, Ohadi MAD, Teo C. Telovelar vs. Transvermian approach for the fourth ventricle tumors: A systematic review and meta-analysis. Clin Neurol Neurosurg 2024; 240:108259. [PMID: 38579552 DOI: 10.1016/j.clineuro.2024.108259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Tumors in the fourth ventricle can be critical due to the small size of the fourth ventricle, which causes symptoms to be detected even in the presence of lesser mass effects. A proper surgical approach to the fourth ventricle poses challenges due to its deep location and proximity to vital compartments within the brainstem. The two commonly used approaches to these tumors are the transvermian and telovelar approaches. METHODS A comprehensive systematic study was conducted based on a literature search of the databases. All case controls, cohorts, and case series including patients with fourth ventricle tumors, who were operated on with either telovelar or transvermian approaches were considered eligible. The evaluated outcomes were comparative postoperative complications of the telovelar vs. transvermian approach. After screening and data extraction, a meta-analysis was performed whenever adequate quantitative data were available. RESULTS Seven studies with a total number of 848 patients, discussed both telovelar and transvermian approaches, with comparative reporting of outcomes in each group. Postoperative outcomes including cranial nerve deficit, mutism, diplopia, CSF leak, need for CSF diversion, and postoperative gait disturbance were not significantly different between telovelar and transvermian approaches. CONCLUSION Postoperative complications were not significantly different between telovelar and transvermian approaches. Moreover, it could be proposed that such complications would be more likely to be a multifactorial matter concerning the patient's clinical condition, tumor characteristics, and surgeon's experience, rather than the surgical approach alone.
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Affiliation(s)
- Sara Hanaei
- Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Borderless Research, Advancement, and Innovation in Neuroscience Network (BRIANet), Tehran, Iran.
| | - Seyed Farzad Maroufi
- Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Neurosurgical Research Network, Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Shaghayegh Sadeghmousavi
- Borderless Research, Advancement, and Innovation in Neuroscience Network (BRIANet), Tehran, Iran; Neurosurgical Research Network, Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Arshia Nejati
- Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Abolfazl Paeinmahalli
- Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Borderless Research, Advancement, and Innovation in Neuroscience Network (BRIANet), Tehran, Iran.
| | - Mohammad Amin Dabbagh Ohadi
- Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Charles Teo
- Centre for Minimally Invasive Neurosurgery, Sydney, Australia; Department of Neurosurgery, NUH, Singapore, Singapore; Department of Neurosurgery, FJD University Hospital, Madrid, Spain; Department of Neurosurgery, Hanoi Medical University, Viet Nam.
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3
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Zhou L, Wei H, Li Z, Zhang H, Song P, Cheng L, Wang W, Lei P, Chen Q, Liu Z, Ye H, Sun D, Cai Q. Treatment of brainstem and fourth ventricle lesions by the full neuroendoscopic telovelar approach. Eur J Med Res 2023; 28:564. [PMID: 38053193 DOI: 10.1186/s40001-023-01460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To explore the surgical techniques, advantages, and disadvantages of neuroendoscopic telovelar approach in the treatment of brainstem and fourth ventricle lesions. METHODS The clinical data of 5 patients treated by neuroendoscopic telovelar approach from March 2020 to March 2022 were analyzed retrospectively. RESULTS Among the 5 patients, there were 3 cavernous hemangiomas in pontine arm and 2 tumors in brainstem and fourth ventricle. All patients could successfully complete the operation, and 4 patients recovered well, other 1 patient discharged automatically for serious complications of other systems after the operation. CONCLUSION The telovelar approach has gained popularity as a safe and effective strategy for lesions in fourth ventricular and brainstem. However, without removing the posterior arch of the atlas, it is difficult to enter the upper part of the fourth ventricle under a microscope. Transcranial neuroendoscopy can effectively compensate for the shortcomings of microscopy, whether used as an auxiliary measure for microsurgery or alone with proficient endoscopic techniques, it will provide greater application in minimally invasive surgery for fourth ventricle and brainstem lesions. By utilizing the excellent degree of freedom of transcranial neuroendoscopy, there is no need to open the posterior arch of the atlas, making the surgery more minimally invasive. However, the sample size of this study is small, and it was completed under the very mature neuroendoscopic technology of our team. Its general safety and practicality still require extensive clinical research validation.
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Affiliation(s)
- Long Zhou
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Hangyu Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Zhiyang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Huikai Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Ping Song
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Li Cheng
- Department of Critical Care Medicine, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenju Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Pan Lei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Zaiming Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Hui Ye
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China
| | - Daofa Sun
- Department of Neurosurgery, Xiantao First People's Hospital of Yangtze University, No. 29, Middle Part of Mianzhou Avenue, Xiantao City, 433000, Hubei Province, China.
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District, Wuhan City, 430060, Hubei Province, China.
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Agosti E, De Maria L, Mattogno PP, Della Pepa GM, D’Onofrio GF, Fiorindi A, Lauretti L, Olivi A, Fontanella MM, Doglietto F. Quantitative Anatomical Studies in Neurosurgery: A Systematic and Critical Review of Research Methods. Life (Basel) 2023; 13:1822. [PMID: 37763226 PMCID: PMC10532642 DOI: 10.3390/life13091822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The anatomy laboratory can provide the ideal setting for the preclinical phase of neurosurgical research. Our purpose is to comprehensively and critically review the preclinical anatomical quantification methods used in cranial neurosurgery. METHODS A systematic review was conducted following the PRISMA guidelines. The PubMed, Ovid MEDLINE, and Ovid EMBASE databases were searched, yielding 1667 papers. A statistical analysis was performed using R. RESULTS The included studies were published from 1996 to 2023. The risk of bias assessment indicated high-quality studies. Target exposure was the most studied feature (81.7%), mainly with area quantification (64.9%). The surgical corridor was quantified in 60.9% of studies, more commonly with the quantification of the angle of view (60%). Neuronavigation-based methods benefit from quantifying the surgical pyramid features that define a cranial neurosurgical approach and allowing post-dissection data analyses. Direct measurements might diminish the error that is inherent to navigation methods and are useful to collect a small amount of data. CONCLUSION Quantifying neurosurgical approaches in the anatomy laboratory provides an objective assessment of the surgical corridor and target exposure. There is currently limited comparability among quantitative neurosurgical anatomy studies; sharing common research methods will provide comparable data that might also be investigated with artificial intelligence methods.
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Affiliation(s)
- Edoardo Agosti
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121 Brescia, Italy; (E.A.); (A.F.); (M.M.F.)
| | - Lucio De Maria
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121 Brescia, Italy; (E.A.); (A.F.); (M.M.F.)
- Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland
| | - Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (P.P.M.); (G.M.D.P.); (L.L.); (A.O.); (F.D.)
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (P.P.M.); (G.M.D.P.); (L.L.); (A.O.); (F.D.)
| | | | - Alessandro Fiorindi
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121 Brescia, Italy; (E.A.); (A.F.); (M.M.F.)
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (P.P.M.); (G.M.D.P.); (L.L.); (A.O.); (F.D.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (P.P.M.); (G.M.D.P.); (L.L.); (A.O.); (F.D.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121 Brescia, Italy; (E.A.); (A.F.); (M.M.F.)
| | - Francesco Doglietto
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (P.P.M.); (G.M.D.P.); (L.L.); (A.O.); (F.D.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
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Microsurgical Management of Fourth Ventricle Lesions Via the Median Suboccipital Keyhole Telovelar Approach. J Craniofac Surg 2023; 34:607-610. [PMID: 35968951 PMCID: PMC9944752 DOI: 10.1097/scs.0000000000008883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
In this 2-year retrospective analysis, 13 patients with fourth ventricle lesions who underwent microsurgical resection via the midline suboccipital keyhole telovelar approach were analyzed. This is the first study to investigate the surgical outcome and complications of using this approach to resect various types of lesions in the fourth ventricle. We aimed to clarify whether this approach has met its promise of lesion dissection. Three patients (23.1%) had intraoperative extraventricular drains. There were no immediate postoperative deaths. Gross total resection was achieved in 84.6% of the cases. The Fisher exact test showed there was no statistically significant correlation between lesion location, lesion size, brainstem invasion, and extent of resection. About two third (69.2%) of the cases were free of complications. New or worsening gait/focal motor disturbance (15.4%) was the most common neurological deficit in the immediate postoperative period. One patient (7.7%) had worse gait disturbance/motor deficit following surgical intervention. Two patients (15.4%) developed meningitis. Two patients (15.4%) required postoperative cerebrospinal fluid diversion after tumor resection, of these 2 patients, 1 (7.7%) eventually needed a permanent shunt. There were no cases of cerebellar mutism and bulbar paralysis. The median suboccipital keyhole telovelar approach provides relative wide access to resect most fourth ventricle tumors completely and with satisfactory results. In contrast, this requires the appropriate patient selection and skilled surgeons.
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6
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Pettersson SD, Jabbar R, Popławska M, Och A, Orrego-Gonzalez E, Klepinowski T, Krakowiak M, Sagan L, Radek M, Zakrzewski K, Nowoslawska E, Kwiecien K, Skrzypkowska P, Szmuda T, Miękisiak G, Vega RA. Telovelar versus transvermian approach to tumors of the fourth ventricle and their impact on postoperative neurological complications: A multicenter study. Surg Neurol Int 2023; 14:124. [PMID: 37151430 PMCID: PMC10159312 DOI: 10.25259/sni_167_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/15/2023] [Indexed: 05/09/2023] Open
Abstract
Background Tumors of the fourth ventricle are exceedingly rare; however, such lesions are formidable due to the severe postoperative neurological complications (pNCs) which often occur. The adoption of the telovelar approach over the transvermian was created to supposedly mitigate the pNCs; however, there is a lack of sufficient data supporting this theory. Methods Records from six hospitals were reviewed for patients surgically treated for a single tumor within the 4th ventricle from 2016 to 2022. The pNCs which had 10 or more occurrences among the patients were individually assessed as the dependent variable in a binary logistic regression model against covariates which included the surgical approach. Results This study of 67 patients confirms no significant differences in risk for pNCs between the transvermian and telovelar approach. Rather, multivariate analysis identified neurophysiological monitoring (IONM) as a protective factor for postoperative speech and swallowing defects (odds ratio [OR]: 0.076, 95% confidence interval [CI] 0.011-0.525). Furthermore, intraoperative external ventricular drainage (EVD) was a protective factor for postoperative gait and focal motor defects (OR: 0.075, 95% CI 0.009-0.648) and for postoperative hydrocephalus (OR: 0.020, 95% CI 0.002-0.233). A univariate meta-analysis pooling the present study's patients and an additional 304 patients from the three additional studies in the literature confirms no significant differences in risk between the transvermian and telovelar approach for pNCs. Conclusion Intraoperative adjuncts including IONM and EVD may play a significant role in the postoperative outcome. Despite the present study's sample size being a major limitation, the findings may provide great value to neurosurgeons given the scarcity of the current literature.
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Affiliation(s)
| | - Redwan Jabbar
- Department of Neurosurgery, Medical University of Lodz, Lodz, Poland
| | | | - Aleksander Och
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland
| | - Eduardo Orrego-Gonzalez
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
| | | | - Michał Krakowiak
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University, Szczecin
| | - Maciej Radek
- Department of Neurosurgery, Medical University of Lodz, Lodz, Poland
| | | | - Emilia Nowoslawska
- Department of Neurosurgery, Polish Mother Memorial Research Institute, Poland
| | - Katarzyna Kwiecien
- Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Lodz, Poland
| | | | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland
| | | | - Rafael A. Vega
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
- Corresponding author: Rafael A. Vega, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States.
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Winter F, Herta J, Niederle M, Furtner J, Rentenberger C, Hedrich C, Roessler K, Dorfer C. Pushing the Limits of the Prone Position in the Intraoperative Magnetic Resonance Suite. Oper Neurosurg (Hagerstown) 2022; 23:e353-e359. [DOI: 10.1227/ons.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
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8
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Franceschi E, Giannini C, Furtner J, Pajtler KW, Asioli S, Guzman R, Seidel C, Gatto L, Hau P. Adult Medulloblastoma: Updates on Current Management and Future Perspectives. Cancers (Basel) 2022; 14:cancers14153708. [PMID: 35954372 PMCID: PMC9367316 DOI: 10.3390/cancers14153708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa belonging to the family of primitive neuro-ectodermic tumors (PNET). MB generally occurs in pediatric age, but in 14–30% of cases, it affects the adults, mostly below the age of 40, with an incidence of 0.6 per million per year, representing about 0.4–1% of tumors of the nervous system in adults. Unlike pediatric MB, robust prospective trials are scarce for the post-puberal population, due to the low incidence of MB in adolescent and young adults. Thus, current MB treatments for older patients are largely extrapolated from the pediatric experience, but the transferability and applicability of these paradigms to adults remain an open question. Adult MB is distinct from MB in children from a molecular and clinical perspective. Here, we review the management of adult MB, reporting the recent published literature focusing on the effectiveness of upfront chemotherapy, the development of targeted therapies, and the potential role of a reduced dose of radiotherapy in treating this disease.
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Affiliation(s)
- Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy
- Correspondence:
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 59005, USA;
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Kristian W. Pajtler
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139 Bologna, Italy
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Lidia Gatto
- Department of Oncology, AUSL of Bologna, 40139 Bologna, Italy;
| | - Peter Hau
- Wilhelm Sander NeuroOncology Unit & Department of Neurology, University Hospital Regensburg, 93055 Regensburg, Germany;
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Nakamura K, Kuge A, Yamaki T, Sano K, Saito S, Kondo R, Sonoda Y. Endovascular Treatment of Hemifacial Spasm Associated with a Tentorial DAVF Using Transarterial Onyx Embolization: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:523-528. [PMID: 37502204 PMCID: PMC10370818 DOI: 10.5797/jnet.cr.2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/15/2022] [Indexed: 07/29/2023]
Abstract
Objective We describe a patient treated with transarterial Onyx embolization for a tentorial dural arteriovenous fistula (DAVF) who presented with hemifacial spasm (HFS). Case Presentation A 56-year-old man suffered from right blepharospasm for 4 years, and the symptom gradually spread to the right side of his face with oculo-oral synkinesis. MRI of the brain revealed abnormal multiple flow voids at the surface of brainstem and cerebellar hemisphere. MRA (time of flight) and spoiled gradient recalled echo-revealed abnormal vessels at the posterior fossa indicated arteriovenous shunting. 3D-MRI fusion images showed that a dilated vein was in contact with the root exit zone (REZ) of the right facial nerve. The right carotid angiography displayed a complex tentorial DAVF on the right side. There were multiple feeding vessels drained to the tentorial sinus at the point where the inferior cerebellar vermian vein met, and severe venous congestion was noted. We diagnosed a tentorial DAVF and thought that this was responsible for the right HFS. We used neuroendovascular treatment for this lesion. After transarterial Onyx embolization, his right HFS diminished. MRI after treatment showed that the vein in contact with the REZ of the right facial nerve had shrank. Conclusion We experienced a rare case of HFS associated with a DAVF. Our case supports that transarterial Onyx embolization can treat HFS associated with a tentorial DAVF. It is the first description of successful treatment that could be confirmed through postoperative MRI.
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Affiliation(s)
- Kazuki Nakamura
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Atsushi Kuge
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
- Department of Emergency Medicine, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Tetsu Yamaki
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Kenshi Sano
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Shinjiro Saito
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Rei Kondo
- Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
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Telovelar Approach: A Practical Guide for Its Expansion to the Fourth Ventricle. World Neurosurg 2021; 148:239-250. [PMID: 33770846 DOI: 10.1016/j.wneu.2020.12.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
Approaches to the fourth ventricle have evolved from the transvermian to the telovelar route. The minimally invasive nature of the telovelar route is advantageous and has become indispensable in reaching the fourth ventricular floor. Nonetheless, the telovelar approach can be restrictive for large and more rostral masses in the ventricle, and therefore certain operative maneuvers are necessary for its safe expansion. Herein, I review some of the technical nuances for extending the reach of this operative corridor.
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11
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Matsushima T, Rutka J, Matsushima K. Evolution of cerebellomedullary fissure opening: its effects on posterior fossa surgeries from the fourth ventricle to the brainstem. Neurosurg Rev 2020; 44:699-708. [PMID: 32281017 DOI: 10.1007/s10143-020-01295-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
Surgical approaches to the fourth ventricle and its surrounding brainstem regions have changed significantly in the previous 30 years, after the establishment of cerebellomedullary fissure (CMF) opening. With the development of CMF opening techniques, CMF opening surgeries have become widely used for the treatment of various pathologies and have contributed to the improvement of surgical results in posterior fossa surgeries. We here review the historical progress of CMF opening surgeries to help the future progression of neurosurgical treatments. The authors studied the available literature to clarify how CMF opening surgeries have developed and progressed, and how much the idea and development of CMF opening techniques have affected the advancement of posterior fossa surgeries. With the establishment of angiography, anatomical studies on CMF in the 1960s were performed mainly to clarify vascular anatomy on radiological images. After reporting the microsurgical anatomy of CMF in a cadaveric study in 1982, one of the authors (T.M.) first proposed the clinical usefulness of CMF opening in 1992. This new method enabled wide exposure of the fourth ventricle without causing vermian splitting syndrome, and it took the place of the standard approach instead of the conventional transvermian approach. Several authors reported their experiences using this method from the end of the twentieth century to the early twenty-first century, and the naming of the approach, "telovelar approach" by Mussi and Rhoton in 2000 contributed to the global spread of CMF opening surgeries. The approach has become widely applied not only for tumors but also for vascular and brainstem lesions, and has assisted in the development of their surgical treatments, and brought up the idea of various fissure dissection in the posterior fossa. Studies of microsurgical anatomy of the fourth ventricle, including the CMF, has led to new surgical approaches represented by the transCMF/telovelar approach. The CMF opening method caused a revolution in posterior fossa surgeries. The idea was developed based on the experience gained while dissecting the CMF (the roof of the fourth ventricle) in the laboratory. Anatomical studies using cadaveric specimens, particularly their dissection by surgeons themselves, together with a deep understanding of brain anatomy are essential for further advancements in neurosurgical treatments.
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Affiliation(s)
- Toshio Matsushima
- International University of Health and Welfare, Fukuoka, Japan. .,Neuroscience Center, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan.
| | - James Rutka
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
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Cavalcanti DD, Morais BA, Figueiredo EG, Spetzler RF, Preul MC. Surgical approaches for the lateral mesencephalic sulcus. J Neurosurg 2019; 132:1653-1658. [PMID: 30978690 DOI: 10.3171/2019.1.jns182036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 01/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The brainstem is a compact, delicate structure. The surgeon must have good anatomical knowledge of the safe entry points to safely resect intrinsic lesions. Lesions located at the lateral midbrain surface are better approached through the lateral mesencephalic sulcus (LMS). The goal of this study was to compare the surgical exposure to the LMS provided by the subtemporal (ST) approach and the paramedian and extreme-lateral variants of the supracerebellar infratentorial (SCIT) approach. METHODS These 3 approaches were used in 10 cadaveric heads. The authors performed measurements of predetermined points by using a neuronavigation system. Areas of microsurgical exposure and angles of the approaches were determined. Statistical analysis was performed to identify significant differences in the respective exposures. RESULTS The surgical exposure was similar for the different approaches-369.8 ± 70.1 mm2 for the ST; 341.2 ± 71.2 mm2 for the SCIT paramedian variant; and 312.0 ± 79.3 mm2 for the SCIT extreme-lateral variant (p = 0.13). However, the vertical angular exposure was 16.3° ± 3.6° for the ST, 19.4° ± 3.4° for the SCIT paramedian variant, and 25.1° ± 3.3° for the SCIT extreme-lateral variant craniotomy (p < 0.001). The horizontal angular exposure was 45.2° ± 6.3° for the ST, 35.6° ± 2.9° for the SCIT paramedian variant, and 45.5° ± 6.6° for the SCIT extreme-lateral variant opening, presenting no difference between the ST and extreme-lateral variant (p = 0.92), but both were superior to the paramedian variant (p < 0.001). Data are expressed as the mean ± SD. CONCLUSIONS The extreme-lateral SCIT approach had the smaller area of surgical exposure; however, these differences were not statistically significant. The extreme-lateral SCIT approach presented a wider vertical and horizontal angle to the LMS compared to the other craniotomies. Also, it provides a 90° trajectory to the sulcus that facilitates the intraoperative microsurgical technique.
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Affiliation(s)
- Daniel Dutra Cavalcanti
- 2Department of Neurological Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | - Robert F Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Mark C Preul
- 1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
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Tong D, Chen X, Lv X, Li K, Xu K, Yu J. Current status of endovascular treatment for dural arteriovenous fistulae in the tentorial middle region: a literature review. Acta Neurol Belg 2019; 119:5-14. [PMID: 30430430 DOI: 10.1007/s13760-018-1044-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
The tentorial middle region (TMR) includes the midline and paramedian tentorium. TMR dural arteriovenous fistulae (DAVFs) are complex. We performed a review of the literature on TMR DAVFs. TMR DAVFs are divided into the following four types: incisural DAVF, Galenic DAVF, straight sinus DAVF and torcular DAVF. TMR DAVFs often drain into pial veins; therefore, most TMR DAVFs are classified as Borden II-III and Cognard types IIb-IV, whose characteristics cause TMR DAVFs to be prone to hemorrhage. TMR DAVFs have a very disappointing natural progression, and treatment is necessary. TMR DAVFs have extensive arterial supply and complex venous drainages, making them difficult to treat. Currently, for TMR DAVF, endovascular treatment (EVT) has become a better option. In EVT, transarterial embolization is the first-line treatment. Many complications can occur when treating TMR DAVFs, but complete EVT can generally achieve good clinical outcomes. In this review, three educational cases with demonstrating figures are provided to elaborate TMR DAVFs.
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Affiliation(s)
- Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Litanglu 168#, Beijing, 102218, China
| | - Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
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Accessing the Anterior Mesencephalic Zone: Orbitozygomatic Versus Subtemporal Approach. World Neurosurg 2018; 119:e818-e824. [DOI: 10.1016/j.wneu.2018.07.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/30/2018] [Indexed: 11/18/2022]
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da Silva SA, Yamaki VN, Solla DJF, Andrade AFD, Teixeira MJ, Spetzler RF, Preul MC, Figueiredo EG. Pterional, Pretemporal, and Orbitozygomatic Approaches: Anatomic and Comparative Study. World Neurosurg 2018; 121:e398-e403. [PMID: 30266695 DOI: 10.1016/j.wneu.2018.09.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although pterional craniotomy and its variants are the most used approaches in neurosurgery, few studies have evaluated their precise indications. We evaluate the pterional (PT), pretemporal (PreT), and orbitozygomatic (OZ) approaches through quantitative measurements of area, linear, and angular exposures of the major intracranial vascular structures. METHODS Eight fresh, adult cadavers were operated with the PT, followed by the PreT, and ending with the OZ approach. The working area, angular exposure of vascular structures and linear exposure of the basilar artery were measured. RESULTS The OZ approach presented a wider area (1301.3 ± 215.9 mm2) with an increase of 456.7 mm2 compared with the PT and of 167.4 mm2 to the PreT (P = 0.011). The extension from PT to PreT and OZ increases linear exposure of the basilar artery. When comparing the PreT and OZ, we found an increase in the horizontal and vertical angle to the bifurcation of the ipsilateral middle cerebral artery (P = 0.005 and P = 0.032, respectively), horizontal angle to the basilar artery tip (P = 0.02), and horizontal angle to the contralateral ICA bifurcation (P = 0.048). CONCLUSIONS The OZ approach offered notable surgical advantages compared with the traditional PT and PreT regarding to the area of exposure and linear exposure to basilar artery. Regarding angle of attack, the orbital rim and zygomatic arch removal provided quantitatively wider exposure and increased surgical freedom. A detailed anatomic study for each patient and surgeon experience must be considered for individualized surgical approach indication.
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Affiliation(s)
- Saul Almeida da Silva
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor Nagai Yamaki
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Davi Jorge Fontoura Solla
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Almir Ferreira de Andrade
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Akiyama O, Matsushima K, Nunez M, Matsuo S, Kondo A, Arai H, Rhoton AL, Matsushima T. Microsurgical anatomy and approaches around the lateral recess with special reference to entry into the pons. J Neurosurg 2017; 129:740-751. [PMID: 29148902 DOI: 10.3171/2017.5.jns17251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The lateral recess is a unique structure communicating between the ventricle and cistern, which is exposed when treating lesions involving the fourth ventricle and the brainstem with surgical approaches such as the transcerebellomedullary fissure approach. In this study, the authors examined the microsurgical anatomy around the lateral recess, including the fiber tracts, and analyzed their findings with respect to surgical exposure of the lateral recess and entry into the lower pons. METHODS Ten cadaveric heads were examined with microsurgical techniques, and 2 heads were examined with fiber dissection to clarify the anatomy between the lateral recess and adjacent structures. The lateral and medial routes directed to the lateral recess in the transcerebellomedullary fissure approach were demonstrated. A morphometric study was conducted in the 10 cadaveric heads (20 sides). RESULTS The lateral recess was classified into medullary and cisternal segments. The medial and lateral routes in the transcerebellomedullary fissure approach provided access to approximately 140º-150º of the posteroinferior circumference of the lateral recess. The floccular peduncle ran rostral to the lateral recess, and this region was considered to be a potential safe entry zone to the lower pons. By appropriately selecting either route, medial-to-lateral or lateral-to-medial entry axis is possible, and combining both routes provided wide exposure of the lower pons around the lateral recess. CONCLUSIONS The medial and lateral routes of the transcerebellomedullary fissure approach provided wide exposure of the lateral recess, and incision around the floccular peduncle is a potential new safe entry zone to the lower pons.
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Affiliation(s)
- Osamu Akiyama
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida.,2Department of Neurosurgery, Juntendo University
| | - Ken Matsushima
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida.,3Department of Neurosurgery, Tokyo Medical University, Tokyo
| | - Maximiliano Nunez
- 4Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | - Satoshi Matsuo
- 5Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | | | - Hajime Arai
- 2Department of Neurosurgery, Juntendo University
| | - Albert L Rhoton
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Toshio Matsushima
- 6Neuroscience Center, Fukuoka Sanno Hospital.,7Graduate School, International University of Health and Welfare, Fukuoka, Japan; and
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Tayebi Meybodi A, Lawton MT, Tabani H, Benet A. Tonsillobiventral fissure approach to the lateral recess of the fourth ventricle. J Neurosurg 2016; 127:768-774. [PMID: 27791522 DOI: 10.3171/2016.8.jns16855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical access to the lateral recess of the fourth ventricle (LR) is suboptimal with existing transvermian and telovelar approaches because of limited lateral exposure, significant retraction of the cerebellar tonsil, and steep trajectories near brainstem perforator arteries. The goal in this study was to assess surgical exposure of the tonsillobiventral fissure approach to the LR, and to describe the relevant anatomy. METHODS Two formaldehyde-fixed cerebella were used to study the anatomical relationships of the LR. Also, the tonsillobiventral fissure approach was simulated in 8 specimens through a lateral suboccipital craniotomy. RESULTS The pattern of the cerebellar folia and the cortical branches of the posterior inferior cerebellar artery were key landmarks to identifying the tonsillobiventral fissure. Splitting the tonsillobiventral fissure allowed a direct and safe surgical trajectory to the LR and into the cerebellopontine cistern. The proposed approach reduces cervical flexion and optimizes the surgical angle of attack. CONCLUSIONS The tonsillobiventral fissure approach is a feasible and effective option for exposing the LR. This approach has more favorable trajectories and positions for the patient and the surgeon, and it should be added to the armamentarium for lesions in this location.
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Affiliation(s)
- Ali Tayebi Meybodi
- Skull Base and Cerebrovascular Laboratory, Department of Neurosurgery, University of California, San Francisco, California
| | - Michael T Lawton
- Skull Base and Cerebrovascular Laboratory, Department of Neurosurgery, University of California, San Francisco, California
| | - Halima Tabani
- Skull Base and Cerebrovascular Laboratory, Department of Neurosurgery, University of California, San Francisco, California
| | - Arnau Benet
- Skull Base and Cerebrovascular Laboratory, Department of Neurosurgery, University of California, San Francisco, California
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18
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Cavalcanti DD, Preul MC, Kalani MYS, Spetzler RF. Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg 2016; 124:1359-76. [DOI: 10.3171/2015.4.jns141945] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECT
The aim of this study was to enhance the planning and use of microsurgical resection techniques for intrinsic brainstem lesions by better defining anatomical safe entry zones.
METHODS
Five cadaveric heads were dissected using 10 surgical approaches per head. Stepwise dissections focused on the actual areas of brainstem surface that were exposed through each approach and an analysis of the structures found, as well as which safe entry zones were accessible via each of the 10 surgical windows.
RESULTS
Thirteen safe entry zones have been reported and validated for approaching lesions in the brainstem, including the anterior mesencephalic zone, lateral mesencephalic sulcus, intercollicular region, peritrigeminal zone, supratrigeminal zone, lateral pontine zone, supracollicularzone, infracollicularzone, median sulcus of the fourth ventricle, anterolateral and posterior median sulci of the medulla, olivary zone, and lateral medullary zone. A discussion of the approaches, anatomy, and limitations of these entry zones is included.
CONCLUSIONS
A detailed understanding of the anatomy, area of exposure, and safe entry zones for each major approach allows for improved surgical planning and dissemination of the techniques required to successfully resect intrinsic brainstem lesions.
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Affiliation(s)
- Daniel D. Cavalcanti
- 1Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil; and
| | - Mark C. Preul
- 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - M. Yashar S. Kalani
- 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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Tsai LK, Liu HM, Jeng JS. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Rev Neurother 2016; 16:307-18. [PMID: 26832225 DOI: 10.1586/14737175.2016.1149063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Borghei-Razavi H, Schick U. Patient adaptable cerebellar retractor system: Use in posterior fossa surgery. INTERDISCIPLINARY NEUROSURGERY 2015. [DOI: 10.1016/j.inat.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tomasello F, Conti A, Cardali S, La Torre D, Angileri FF. Telovelar Approach to Fourth Ventricle Tumors: Highlights and Limitations. World Neurosurg 2015; 83:1141-7. [DOI: 10.1016/j.wneu.2015.01.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/25/2022]
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Figueiredo EG, Bor-Seng-Shu E, Spetzler RF, Preul MC. Analytical anatomy: quantifying surgical access with and without orbital bar removal--cadaver and surgical phantom studies. Acta Neurochir (Wien) 2014; 156:1633-4. [PMID: 24770730 DOI: 10.1007/s00701-014-2093-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 03/31/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Eberval Gadelha Figueiredo
- Division of Neurological Surgery, University of Sao Paulo, Rua Eneas C. Aguiar, 255, CEP 05409-010, São Paulo, SP, Brazil,
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Matsushima T, Kawashima M, Inoue K, Matsushima K, Miki K. Exposure of wide cerebellomedullary cisterns for vascular lesion surgeries in cerebellomedullary cisterns: opening of unilateral cerebellomedullary fissures combined with lateral foramen magnum approach. World Neurosurg 2014; 82:e615-21. [PMID: 24793562 DOI: 10.1016/j.wneu.2014.04.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/27/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To clarify microsurgical anatomic features of the cerebellomedullary fissure (CMF), the natural cleavage plane between the cerebellum and the medulla, and its relationship to the cerebellomedullary cistern (CMC) and to describe a surgical technique that uses the unilateral trans-CMF approach for CMC surgeries. METHODS In the anatomic study, 2 formalin-fixed cadaver heads were used. In the clinical study, 3 patients with vertebral artery-posterior inferior cerebellar artery aneurysms and 3 patients with glossopharyngeal neuralgia were surgically treated through the unilateral trans-CMF approach combined with the transcondylar fossa approach, which is a lateral foramen magnum approach. RESULTS The CMC was present at the lateral end of the CMF. The CMF was closed by arachnoidal adhesion, and the cerebellar hemisphere was superiorly attached to the cerebellar peduncle. After the unilateral CMF was completely opened, the cerebellar hemisphere was easily retracted rostrodorsally. Clinically, almost completely opening the unilateral CMF markedly enabled the retraction of the biventral lobule to obtain a wide surgical field safely for vascular CMC lesions. We present 2 representative cases. CONCLUSION Combined unilateral trans-CMF/lateral foramen magnum approaches provide a wide and close surgical field in the CMC, allowing easy and safe CMC surgery.
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Affiliation(s)
- Toshio Matsushima
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
| | - Kohei Inoue
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Ken Matsushima
- Department of Surgical Neurology, University of Florida, Gainesville, Florida, USA
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Kayaci S, Caglar YS, Bas O, Ozveren MF. Importance of the perforating arteries in the proximal part of the PICA for surgical approaches to the brain stem and fourth ventricle - an anatomical study. Clin Neurol Neurosurg 2013; 115:2153-8. [DOI: 10.1016/j.clineuro.2013.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 06/29/2013] [Accepted: 08/04/2013] [Indexed: 11/29/2022]
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Ramanathan D, Temkin N, Kim LJ, Ghodke B, Sekhar LN. Cerebral bypasses for complex aneurysms and tumors: long-term results and graft management strategies. Neurosurgery 2012; 70:1442-57; discussion 1457. [PMID: 22278357 DOI: 10.1227/neu.0b013e31824c046f] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various techniques of cerebral bypasses are used to treat aneurysms and tumors. OBJECTIVE To study long-term clinical and radiological outcome of various bypass types and to analyze techniques used in the management of long-term graft problems. METHODS A consecutive series of patients who underwent revascularization during a 5-year period were analyzed for indications, graft patency, and neurological outcomes. Potential risk factors for bypass problems and the management of bypass stenosis were studied. RESULTS A total of 80 patients (69 with aneurysms and 11 with tumors) underwent 88 bypasses (59 extracranial-to-intracranial [EC-IC] bypasses [10 low flow, 49 high flow], 9 intracranial-to-intracranial [IC-IC] bypasses [3 long, 6 short], and 20 local bypasses), with mean radiological follow-up of 32 months (range, 1-53 months). At late follow-up, 5 of 9 (56%) IC-IC (5 short, 0 long grafts), 8 of 9 (90%) EC-IC low-flow, 44 of 48 (92%) EC-IC high-flow, and all local bypasses were patent. Four patients with EC-IC high-flow bypass occlusions were asymptomatic, but transient ischemic attacks were noted in 3 of 6 patients with graft stenosis. None of the risk factors evaluated were significantly predictive of EC-IC graft occlusions or stenosis. EC-IC HF graft stenoses were permanently corrected by microsurgery (n = 4) or endovascular surgery (n = 1). CONCLUSION The EC-IC and local bypasses have higher long-term patency rates (91% and 100%) compared with IC-IC bypasses (66%, 0% long graft). Some EC-IC bypasses may occlude asymptomatically (9%) or develop graft stenosis (13%) over the long term. Microsurgical and endovascular surgical techniques have been developed to treat graft stenosis.
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Affiliation(s)
- Dinesh Ramanathan
- Department of Neurological Surgery, University of Washington, Seattle, Washington 98104, USA
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Matsushima T, Abe H, Kawashima M, Inoue T. Exposure of the wide interior of the fourth ventricle without splitting the vermis: importance of cutting procedures for the tela choroidea. Neurosurg Rev 2012; 35:563-71; discussion 571-2. [PMID: 22527626 DOI: 10.1007/s10143-012-0384-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 03/03/2012] [Indexed: 12/01/2022]
Abstract
In recent years, new procedures for fourth ventricular surgeries have been developed with good results. In particular, the trans-cerebellomedullary fissure approach, which exposes the fourth ventricle without splitting the inferior vermis, has proven successful. For optimum results, specialized techniques should be employed in order to effectively open the roof of the fourth ventricle and obtain a wide exposure of its interior. These techniques include the following steps: (1) placement of an incision over the teania extending from the foramen of Magendie to the ventricular entrance of the lateral recess; (2) lateral extension of the incision to the roof of the lateral recess to facilitate its exposure; (3) implementation of the same procedure on the contralateral side. Upon completion of these steps, the bilateral cerebellar tonsils can be easily retracted superolaterally; this eventually exposes a wide interior of the ventricle. In order to ensure successful surgeries, explicit and accurate descriptions of technique are vital. In this article, we employ detailed illustrations to precisely demonstrate the operative procedures and techniques for fourth ventricular surgeries.
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Affiliation(s)
- Toshio Matsushima
- Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-shi, Saga, 849-8501, Japan.
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Li T, Lv X, Wu Z. Endovascular treatment of hemifacial spasm associated with a petrosal DAVF using transarterial Onyx embolization. A case report. Interv Neuroradiol 2012; 18:69-73. [PMID: 22440603 PMCID: PMC3312092 DOI: 10.1177/159101991201800109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/11/2011] [Indexed: 02/05/2023] Open
Abstract
This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.
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Affiliation(s)
- T Li
- The First Affiliated Hospital of Henan Science and Technology University, Luoyang, Henan, China
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Endoscopic telovelar approach to the fourth ventricle: anatomic study. Neurosurg Rev 2011; 35:341-8; discussion 348-9. [DOI: 10.1007/s10143-011-0371-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/24/2011] [Accepted: 10/08/2011] [Indexed: 10/14/2022]
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Ochalski PG, Fernandez-Miranda JC, Prevedello DM, Pollack IF, Engh JA. Endoscopic Port Surgery for Resection of Lesions of the Cerebellar Peduncles: Technical Note. Neurosurgery 2011; 68:1444-50; discussion 1450-1. [DOI: 10.1227/neu.0b013e31820b4f6a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Mass lesions of the inferior, middle, and superior cerebellar peduncles (cerebellar peduncle complex [CPC]) present numerous surgical pitfalls when resection or debulking is warranted. Success has been achieved through multiple approaches, but complications can be severe.
OBJECTIVE:
To report the surgical technique for and clinical results of the treatment of lesions in the CPC with an endoscopic port via a lateral transcerebellar corridor.
METHODS:
Three patients underwent resection of intrinsic lesions of the CPC via a lateral transcerebellar approach with an endoscopic port. Deployment of the port was performed with frameless image-guided placement into the area of interest. Resection was performed using bimanual microsurgical technique under parallel endoscopic visualization.
RESULTS:
Three patients 43, 27, and 13 years of age underwent successful resection of lesion in the CPC. Histopathological diagnosis consisted of cavernous malformation, glioblastoma multiforme, and a juvenile pilocytic astrocytoma. All had complete gross total resection except for the patient with a high-grade glioma. Clinically, all had excellent outcomes, with 1 patient suffering postoperative facial palsy after resection of her high-grade glioma.
CONCLUSION:
The lateral transcerebellar approach to the CPC with an endoscopic port may be a feasible alternative to standard microsurgical resection in such difficult cases. Careful patient selection is critical to identify those who may be suitable for endoscopic port surgery on the basis of clinical, radiographic, and anatomical considerations.
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Affiliation(s)
- Pawel G. Ochalski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C. Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel M. Prevedello
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ian F. Pollack
- Department of Pediatric Neurosurgery, The Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Johnathan A. Engh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Yaltho TC, Jankovic J. The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord 2011; 26:1582-92. [PMID: 21469208 DOI: 10.1002/mds.23692] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/29/2011] [Accepted: 02/03/2011] [Indexed: 11/06/2022] Open
Abstract
Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n=23, 11%), facial nerve injury (n=13, 6%), demyelination (n=2), and brain vascular insults (n=2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features.
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Affiliation(s)
- Toby C Yaltho
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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31
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Gu Y, Zhu W, Zhang XB, Hou YY, Xie T. Enterogenous cyst as a rare cause of hemifacial spasm. J Clin Neurosci 2011; 18:574-6. [PMID: 21334209 DOI: 10.1016/j.jocn.2010.07.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 11/26/2022]
Abstract
Hemifacial spasm (HFS) is most frequently caused by vascular compression of the facial nerve at the root exit zone of the brain stem, but there are other rare causes. An enterogenous cyst (EC) is a rare congenital lesion which occurs rarely in the cerebellopontine angle. The authors report a patient with HFS from an EC and review unusual causes of HFS.
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Affiliation(s)
- Ye Gu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
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32
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Schneider UC, von Weitzel-Mudersbach P, Hoffmann KT, Vajkoczy P. Extracranial Posterior Communicating Artery Bypass for Revascularization of Patients With Common Carotid Artery Occlusion. Neurosurgery 2010; 67:1783-9; discussion 1789. [DOI: 10.1227/neu.0b013e3181fa325b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Extracranial-intracranial bypass surgery provides blood flow augmentation in patients suffering from intracranial or long-distance conductance artery stenosis or occlusion that otherwise cannot be treated. The standard procedure for these cases is an anastomosis between the superficial temporal and middle cerebral arteries. However, in patients presenting with common carotid artery occlusion, the superficial temporal artery is no longer sufficiently perfused. For these patients, alternative revascularization strategies have to be applied.
OBJECTIVE:
To describe a novel strategy for revascularization of patients with common carotid artery occlusion, ie, the extracranial posterior communicating artery bypass.
METHODS:
Two patients with chronic cerebrovascular compromise resulting in transitory ischemic attacks and/or border-zone infarctions caused by common carotid artery occlusion were referred to our institution. A radial artery bypass was established between the third segment of the vertebral artery and an M3 branch of the middle cerebral artery. The vertebral artery was exposed between the vertebral lamina of C1 and occipital bone via a paramedian incision. The bypass was tunneled subcutaneously, conducted intracranially via a tailored extended burr-hole craniotomy, and anastomosed to a recipient M3 vessel.
RESULTS:
The postoperative course of both patients was uneventful in terms of cerebral ischemia or bleeding complications. In both patients, postoperative angiographic controls revealed an excellent bypass function with markedly improved hemispheric filling of multiple middle cerebral artery branches. The patients were discharged without new neurological symptoms.
CONCLUSION:
Our extracranial posterior communicating artery bypass using a radial artery transplant from the vertebral artery to the middle cerebral artery is a useful tool to treat patients suffering from hemodynamic cerebrovascular compromise caused by common carotid artery occlusion.
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Borha A, Emery E, Courtheoux P, Lefevre P, Derlon JM. Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report. Acta Neurochir (Wien) 2010; 152:1745-53. [PMID: 20635104 DOI: 10.1007/s00701-010-0722-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge. Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up, because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of the aggravation mechanism are discussed.
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Giliberto G, Lanzino DJ, Diehn FE, Factor D, Flemming KD, Lanzino G. Brainstem cavernous malformations: anatomical, clinical, and surgical considerations. Neurosurg Focus 2010; 29:E9. [DOI: 10.3171/2010.6.focus10133] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic brainstem cavernous malformations carry a high risk of permanent neurological deficit related to recurrent hemorrhage, which justifies aggressive management. Detailed knowledge of the microscopic and surface anatomy is important for understanding the clinical presentation, predicting possible surgical complications, and formulating an adequate surgical plan. In this article the authors review and illustrate the surgical and microscopic anatomy of the brainstem, provide anatomoclinical correlations, and illustrate a few clinical cases of cavernous malformations in the most common brainstem areas.
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Affiliation(s)
- Giuliano Giliberto
- 1Operative Unit of Neurosurgery, Nuovo Ospedale Civile, Modena, Italy; and Departments of
- 6Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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35
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Jittapiromsak P, Sabuncuoglu H, Deshmukh P, Spetzler RF, Preul MC. Accessing the recesses of the fourth ventricle: comparison of tonsillar retraction and resection in the telovelar approach. Neurosurgery 2010; 66:30-9; discussion 39-40. [PMID: 20173570 DOI: 10.1227/01.neu.0000348558.35921.4e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of the telovelar approach with tonsillar manipulation for approaching the recesses of the fourth ventricle. METHODS A telovelar approach was performed in 8 injected cadaveric heads. Areas of exposure were measured for the superolateral and lateral recesses. Horizontal angles were evaluated by targeting the cerebral aqueduct and medial margin of the lateral recess. Quantitative comparisons were made between the telovelar dissections and various tonsillar manipulations. RESULTS Tonsillar retraction provided a comparable exposure of the superolateral recess with tonsillar resection (26.4 +/- 17.6 vs 25.2 +/- 12.5 mm2, respectively; P = .825). Tonsillar resection significantly increased exposure of the lateral recess compared with tonsillar retraction (31.1 +/- 13.3 vs 20.2 +/- 11.5 mm2, respectively; P = .002). Compared with tonsillar retraction, the horizontal angle to the lateral recess increased after either contralateral tonsillar retraction (22.7 +/- 4.8 vs 36.7 +/- 6.5 degrees) or tonsillar resection (22.7 +/- 4.8 vs 31.5 +/- 7.6 degrees; all adjusted P < .01). The horizontal angle to the cerebral aqueduct increased significantly with tonsillar resection compared with tonsillar retraction (17.6 +/- 2.3 vs 13.2 +/- 2.8 degrees; P < .001) CONCLUSION Compared with tonsillar retraction, tonsillar resection provides a wider corridor to, and a larger area of exposure of, the cerebral aqueduct and lateral recess. Contralateral tonsillar retraction improves access to the lateral recess by widening the surgical view from the contralateral side.
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Affiliation(s)
- Pakrit Jittapiromsak
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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36
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Zaheer SN, Wood M. Experiences with the telovelar approach to fourth ventricular tumors in children. Pediatr Neurosurg 2010; 46:340-3. [PMID: 21346396 DOI: 10.1159/000321539] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 09/28/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fourth ventricular tumors are amongst the most common tumors in the pediatric population. Traditionally, these tumors are approached through the cerebellar vermis, but the telovelar approach is now becoming widespread. Posterior fossa syndrome/cerebellar mutism is a complication of surgery for fourth ventricular tumors whose precise cause remains elusive, but may be related to the surgical approach or injury to adjacent cerebellar structures. We present a small series of fourth ventricular tumors and our initial experience in using the telovelar approach for this surgery. METHODS Twenty patients with fourth ventricular tumors were operated on using the microsurgical telovelar approach, sparing the cerebellar vermis. Data were collected prospectively for all patients with respect to the degree of resection achieved, complications and the incidence of posterior fossa syndrome. RESULTS A complete resection was achieved on postoperative MRI in 70% of the patients. Residual disease <1.5 cm(3) remained in 15% and a further 15% had subtotal resection with >1.5 cm(3) of residual disease. Thirty percent had evidence of posterior fossa syndrome in the postoperative period, of which 84% had resolved at the last follow-up. Thirty percent of the patients developed symptomatic hydrocephalus requiring shunting. There were no new neurological deficits and no procedure-related deaths. CONCLUSION The telovelar approach provides excellent access to tumors of the fourth ventricle with sparing of the vermis in children. The high incidence of cerebellar mutism in our patients confirms that this phenomenon is unlikely to be related to vermian injury and further study is recommended.
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Mitsuhashi Y, Aurboonyawat T, Pereira VM, Geibprasert S, Toulgoat F, Ozanne A, Lasjaunias P. Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg 2009; 111:889-99. [PMID: 19425886 DOI: 10.3171/2009.1.jns08840] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. METHODS Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. RESULTS Both of these "extrasinusal"-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. CONCLUSIONS Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.
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Affiliation(s)
- Yutaka Mitsuhashi
- Service de Neuroradiologie Diagnostique et Therapeutique, Hospital de Bicêtre, Paris, France.
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38
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Abstract
Surgery is an integral component and typically the first line of therapy for children with central nervous system tumors. The outcome with regard to surgical morbidity and disease control can be greatly influenced by the initial care that these children receive. Conventional aims of neurosurgery including tumor removal, management of hydrocephalus, and diagnostic sampling have been radically modified with innovative technologies such as navigational guidance, functional mapping, endoscopic surgery, second-look surgery, and physiologic imaging. The overall role of the pediatric neurosurgeon in caring for children with nervous system tumors is also expanding to include unconventional responsibilities including disease staging, tissue procurement, and drug delivery. It is thus anticipated that the pediatric neurosurgeon will be increasingly relied upon for oncologic therapeutic strategies and should thus remain abreast of forthcoming information and technologies.
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Affiliation(s)
- Mark M Souweidane
- Departments of Neurological Surgery and Pediatrics, Weill Cornell Medical College and Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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39
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Dammers R, Delwel EJ, Krisht AF. Cavernous hemangioma of the mesencephalon: tonsillouveal transaqueductal approach. Neurosurgery 2009; 64:296-9; discussion 299-300. [PMID: 19404108 DOI: 10.1227/01.neu.0000341530.36757.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Recent advances in microsurgical techniques facilitate surgical resection of brainstem lesions that were previously considered inoperable. In this article we present, for the first time, the tonsillouveal transaqueductal approach to access a progressively symptomatic cavernoma within the depth of the tegmentum of the mesencephalon. METHODS A 52-year-old woman presented with a history of slowly progressive right-sided hemiparesis and ataxia. On magnetic resonance imaging, a relatively large cavernoma involving the tegmentum of the mesencephalon was shown. The sylvian aqueduct was patent and there was no secondary ventriculomegaly. The patient underwent surgery via a suboccipital craniotomy and C1 laminectomy. The right tonsillouveal and medullotonsillar spaces were opened to the level of the choroidal point of the posteroinferior cerebellar artery. The tela choroidea was incised from the foramen of Magendie to the telovelar junction. Looking through the aqueduct and at a point 5 mm superior to its inferior inlet, there was a small cherry-like blister protruding into the aqueductal anterior surface. This was used as an entry point to access the cavernoma. The space around the cavernoma was gently dissected and the cavernoma was circumferentially coagulated to shrink it in a concentric manner toward its center. RESULTS The total removal of the lesion was achieved and the histopathological findings were consistent with a cavernoma. As a result of noncommunicating hydrocephalus, the patient needed a ventriculoperitoneal shunt. The 1-year postoperative neurological examination was consistent with preoperative findings. CONCLUSION This report shows, for the first time, direct surgical removal of a cavernous hemangioma in the mesencephalic tegmentum via the aqueduct. This approach adds to contemporary microneurosurgery, respecting functional anatomy and minimizing neurological deficits.
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Affiliation(s)
- Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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40
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Jiang C, Lv X, Li Y, Zhang J, Wu Z. Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 2009; 51:103-11. [PMID: 18989665 DOI: 10.1007/s00234-008-0473-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/22/2008] [Indexed: 02/07/2023]
Abstract
INTRODUCTION An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously. MATERIALS AND METHODS Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix. RESULTS Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%. CONCLUSION High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery.
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Affiliation(s)
- Chuhan Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Lv X, Jiang C, Li Y, Yang X, Wu Z. Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx. Interv Neuroradiol 2008; 14:415-27. [PMID: 20557741 PMCID: PMC3313809 DOI: 10.1177/159101990801400407] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 07/25/2008] [Indexed: 02/05/2023] Open
Abstract
SUMMARY This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization. Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11-70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome. Data for 23 patients (age range, 11-70 yrs, mean age 49.5yrs) with DAVFs (cavernous sinus[ CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment. The mean clinical follow-up period was 22.1 months. Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
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42
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Panagiotopoulos V, Kastrup O, Wanke I. Endovascular treatment resolves non-hemorrhagic brainstem dysfunction due to tentorial dural AV fistula. J Clin Neurosci 2008; 16:317-20. [PMID: 19091572 DOI: 10.1016/j.jocn.2008.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 02/18/2008] [Indexed: 10/21/2022]
Abstract
Tentorial dural arteriovenous fistulas (tDAVF) clinically present usually with subarachnoid and/or intraparenchymal hemorrhage. Reported rates range from 58% to 92% and neurological deficits occur in 79% to 92% of patients. This is due to venous congestion resulting from retrograde leptomeningeal venous drainage, which rarely, can be clinically silent. A 69-year-old woman presented with vertigo, double vision and gait instability. Cerebral digital subtraction angiography revealed a tDAVF with retrograde cerebellar venous drainage directed through the vein of Galen into the straight sinus. MRI showed extensive cerebellar edema due to venous congestion. Clinical manifestations of cerebellar and brainstem dysfunction resolved completely after transarterial embolization with N-butylcyanoacrylate.
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Affiliation(s)
- V Panagiotopoulos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Hufelandstrasse 55, D-45122, Essen, Germany
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Lv X, Jiang C, Li Y, Wu Z. Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18. J Neurosurg 2008; 109:1083-90. [PMID: 19035723 DOI: 10.3171/jns.2008.109.12.1083] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT Use of the Onyx liquid embolic system has become an option for treating dural arteriovenous fistulas (DAVFs) because of its advantageous nonadhesive and cohesive properties. However, the complication rates associated with the use of this system have not been reported. The authors present their initial experience of the risks related to transarterial embolization using this system. METHODS Between February 2005 and February 2007, 31 patients with DAVFs were treated at Beijing Tiantan Hospital. Transarterial embolization using Onyx-18 was performed as a preoperative adjunct or as definitive therapy. The demographic characteristics, angiographic features, clinical presentation, treatment, and outcome of the patients were reviewed. Clinical follow-up status was supplemented by telephone interviews to determine Glasgow Outcome Scale scores. RESULTS In 19 patients (61.3%) there was complete angiographic evidence of elimination of the shunts and resolution of the symptoms. The remaining 12 patients were treated successfully but did not attain complete embolization and had residual shunting. Adverse events occurred in 5 of 31 patients, with 3 DAVFs located at the tentorium, 1 at the inferior petrosal sinus, and 1 at the cavernous sinus. Complications included trigeminocardiac reflex in 2 patients (6.5%), hemifacial hypesthesia in 3 patients (9.7%), hemifacial palsy in 2 patients (6.5%), jaw pain in 1 patient (3.2%), posterior fossa infarction in 1 patient (3.2%), and microcatheter gluing in 1 patient (3.2%). At the last follow-up examination, all patients had returned to an independent clinical status. CONCLUSIONS Although a complete resolution of symptoms can be achieved with transarterial embolization using the Onyx liquid embolic system, the potential for serious complications exists with this procedure, necessitating the participation of a skilled neurointerventionalist.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Kim JP, Park BJ, Choi SK, Rhee BA, Lim YJ. Microvascular decompression for hemifacial spasm associated with vertebrobasilar artery. J Korean Neurosurg Soc 2008; 44:131-5. [PMID: 19096662 DOI: 10.3340/jkns.2008.44.3.131] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 08/18/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. METHODS Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004, the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features, the compression patterns of the vessels at the time of surgery and treatment outcomes. RESULTS There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%), and in 27 cases (34.2%) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). CONCLUSION In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.
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Affiliation(s)
- Joo Pyung Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
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Hermann EJ, Rittierodt M, Krauss JK. Combined Transventricular and Supracerebellar Infratentorial Approach Preserving the Vermis in Giant Pediatric Posterior Fossa Midline Tumors. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000316853.47780.b9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Elvis J. Hermann
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Marion Rittierodt
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
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D'Ambrosio AL, Mocco J, Hankinson TC, Bruce JN, van Loveren HR. Quantification of the frontotemporal orbitozygomatic approach using a three-dimensional visualization and modeling application. Neurosurgery 2008; 62:251-60; discussion 260-1. [PMID: 18424994 DOI: 10.1227/01.neu.0000317401.38960.f6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We sought to simulate the frontotemporal orbitozygomatic (FTOZ) craniotomy in a three-dimensional virtual environment on patient-specific data and to quantify the exposure afforded by the FTOZ while simulating controlled amounts of brain retraction. METHODS Four computed tomographic angiograms were reconstructed with commercially available software (Amira 4.1.1; Mercury Computer Systems, Inc., Chelmsford, MA), and virtual FTOZ craniotomies were performed bilaterally (n = 8). Brain retraction was simulated at 1 and 2 cm. Surgical freedom and projection angle were measured and compared at each stage of the FTOZ. RESULTS At 1 cm of retraction, surgical freedom increased by 27 +/- 14% for the removal of the orbital rim and by 31 +/- 18% for FTOZ (P < 0.01) when compared with frontotemporal (FT) craniotomy. At 2 cm of retraction, surgical freedom increased by 15 +/- 5% and 26 +/- 8% for the removal of the orbital rim and FTOZ, respectively (P < 0.01). With increased retraction, surgical freedom increased by 100 +/- 26%, 81 +/- 15%, and 82 +/- 27% for the FT, removal of the orbital rim, and FTOZ craniotomies, respectively (P < 0.001). Projection angle increased by 24.2% when orbital rim removal was added to the FT craniotomy (P < 0.01). CONCLUSION Surgical freedom increases significantly at every step of the FTOZ craniotomy. This effect is less robust when brain retraction is increased. Brain retraction alone has a greater impact on surgical freedom than bone removal alone. Projection angle is significantly increased when orbital rim removal is added to the FT craniotomy. This model overcomes two major limitations of cadaver-based models: quantification of brain retraction and incorporation of patient-specific anatomy.
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Affiliation(s)
- Anthony L D'Ambrosio
- Department of Neurological Surgery, Columbia University, New York, New York 10032, USA
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Lv X, Jiang C, Li Y, Yang X, Wu Z. Transarterial embolization of tentorial dural arteriovenous fistulas with onyx 18. Neuroradiol J 2008; 21:406-14. [PMID: 24256913 DOI: 10.1177/197140090802100318] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 12/26/2007] [Indexed: 02/05/2023] Open
Abstract
Dural arteriovenous fistulas (DVAFs) have been reported to be treated transarterially with Onyx 18. We present a series of tentorial DAVFs treated by transarterial embolization with Onyx 18 over an 18-month period. Eight patients with tentorial DAVFs were treated between September 2005 and February 2007. All patients were treated transarterially with Onyx 18. The clinical presentation, treatment strategies and results were studied. Eight patients presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in every patient, classifying the lesions as Cognard Type IV. Post treatment angiography demonstrated complete obliteration in six cases. Clinical follow up ranged from six to 14 months. One patient experienced neurological decline after endovascular treatment and exhibited clinical improvement. There were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in seven patients, fair in one case. Transarterial embolization of tentorial DAVF is feasible and may result in complete occlusion of the fistulous connection with liquid nonadhesives.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical institute, Beijing, the People's Republic of China - Beijing Tiantan Hospital, Capital Medical University, Beijing, the People's Republic of China -
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Jiang C, Lv X, Li Y, Wu Z. Transarterial and transvenous embolization of a tentorial dural arteriovenous fistula. A case report. Neuroradiol J 2007; 20:726-9. [PMID: 24300009 DOI: 10.1177/197140090702000618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 07/18/2007] [Indexed: 02/05/2023] Open
Abstract
Various treatments of tentorial dural arteriovenous fistulas have been assessed, but there are only two pertinent literature reports on percutaneous transvenous coil embolization. We describe the case of a patient with tentorial dural arteriovenous fistula coiled transvenously.
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Affiliation(s)
- Chuhan Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
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Safavi-Abbasi S, Zabramski JM, Deshmukh P, Reis CV, Bambakidis NC, Theodore N, Crawford NR, Spetzler RF, Preul MC. Moving toward the petroclival region: a model for quantitative and anatomical analysis of tumor shift. J Neurosurg 2007; 107:797-804. [PMID: 17937226 DOI: 10.3171/jns-07/10/0797] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors quantitatively assessed the effects of balloon inflation as a model of tumor compression on the brainstem, cranial nerves, and clivus by measuring the working area, angle of attack, and brain shift associated with the retrosigmoid approach. METHODS Six silicone-injected cadaveric heads were dissected bilaterally via the retrosigmoid approach. Quantitative data were generated, including key anatomical points on the skull base and brainstem. All parameters were measured before and after inflation of a balloon catheter (inflation volume 4.8 ml, diameter 20 mm) intended to mimic tumor compression. RESULTS Balloon inflation significantly shifted (p < 0.001) the brainstem and cranial nerve foramina (mean [+/- standard deviation] displacement of upper brainstem, 10.2 +/- 3.7 mm; trigeminal nerve exit, 6.99 +/- 2.38 mm; facial nerve exit, 9.52 +/- 4.13 mm; and lower brainstem, 13.63 +/- 8.45 mm). The area of exposure at the petroclivus was significantly greater with balloon inflation than without (change, 316.26 +/- 166.75 mm2; p < 0.0001). Before and after balloon inflation, there was no significant difference in the angles of attack at the origin of the trigeminal nerve (p > 0.5). CONCLUSIONS This study adds an experimental component to the emerging field of quantitative neurosurgical anatomy. Balloon inflation can be used to model the effects of a mass lesion. The tumor simulation created "natural" retraction and an opening toward the upper clivus. The findings may be helpful in selecting a surgical approach to increase the working space for resection of certain extraaxial tumors.
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Affiliation(s)
- Sam Safavi-Abbasi
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Rajesh BJ, Rao BRM, Menon G, Abraham M, Easwer HV, Nair S. Telovelar approach: technical issues for large fourth ventricle tumors. Childs Nerv Syst 2007; 23:555-8. [PMID: 17415573 DOI: 10.1007/s00381-006-0295-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 12/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTS Fourth ventricle is conventionally accessed via resection of the part of the vermis for total excision of the tumors at the expense of significant morbidity. Numerous avenues have been identified to minimize the morbidity; some of which include transforaminal, subtonsillar, telovelar approaches, etc. These approaches are devised on the basis that accurate dissection along the natural avascular planes will avoid injury to the important structures in this area minimizing morbidity. We attempt to emphasize the technique of telovelar approach and the problems encountered while employing this technique for excision of large fourth ventricle tumors. MATERIALS AND METHODS Fifteen patients with fourth ventricle tumors were operated during January to September 2005 at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Fourteen of these cases were medulloblastomas, and one was ependymoma. All the patients were operated in prone oblique position via telovelar approach. CONCLUSION Clear understanding of the normal anatomy will help in meticulous dissection and will result in reduced morbidity. Significant incidence of postoperative ataxia and mutism is seen with this approach in large tumors, and this can be avoided by staged dissection of the uvulotonsillar cleft.
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Affiliation(s)
- B J Rajesh
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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