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Open Access 04-05-2024 | CSF Drainage | Research

The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary?

Authors: Anna Cho, Maria Aliotti Lippolis, Johannes Herta, Muhammet Dogan, Cora Hedrich, Amedeo A. Azizi, Andreas Peyrl, Johannes Gojo, Thomas Czech, Christian Dorfer

Published in: Child's Nervous System | Issue 9/2024

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Abstract

Purpose

Various surgical nuances of the telovelar approach have been suggested. The necessity of removing the posterior arch of C1 to accomplish optimal tumor exposure is still debated. Therefore, we report on our experience and technical details of the fourth ventricular tumor resection in a modified prone position without systematic removal of the posterior arch of C1.

Methods

A retrospective analysis of all pediatric patients, who underwent a fourth ventricular tumor resection in the modified prone position between 2012 and 2021, was performed.

Results

We identified 40 patients with a median age of 6 years and a M:F ratio of 25:15. A telovelar approach was performed in all cases. In 39/40 patients, the posterior arch of C1 was not removed. In the remaining patient, the reason for removing C1 was tumor extension below the level of C2 with ventral extension. Gross or near total resection could be achieved in 34/39 patients, and subtotal resection in 5/39 patients. In none of the patients, a limited exposure, sight of view, or range of motion caused by the posterior arch of C1 was encountered, necessitating an unplanned removal of the posterior arch of C1. Importantly, in none of the cases, the surgeon had the impression of a limited sight of view to the most rostral parts of the fourth ventricle, which necessitated a vermian incision.

Conclusion

A telovelar approach without the removal of the posterior arch of C1 allows for an optimal exposure of the fourth ventricle provided that critical nuances in patient positioning are considered.
Literature
1.
go back to reference Kulubya ES, Kercher MJ, Phillips HW, Antony R, Edwards MSB (2022) Advances in the treatment of pediatric brain tumors. Children (Basel) 10(1) Kulubya ES, Kercher MJ, Phillips HW, Antony R, Edwards MSB (2022) Advances in the treatment of pediatric brain tumors. Children (Basel) 10(1)
2.
go back to reference Baro V, Lavezzo R, Marton E, Longatti P, Landi A, Denaro L, d’Avella D (2019) Prone versus sitting position in pediatric low-grade posterior fossa tumors. Childs Nerv Syst 35(3):421–428CrossRefPubMed Baro V, Lavezzo R, Marton E, Longatti P, Landi A, Denaro L, d’Avella D (2019) Prone versus sitting position in pediatric low-grade posterior fossa tumors. Childs Nerv Syst 35(3):421–428CrossRefPubMed
3.
go back to reference Mavarez-Martinez A, Israelyan LA, Soghomonyan S, Fiorda-Diaz J, Sandhu G, Shimansky VN, Ammirati M, Palettas M, Lubnin AY, Bergese SD (2020) The effects of patient positioning on the outcome during posterior cranial fossa and pineal region surgery. Front Surg 7:9CrossRefPubMedPubMedCentral Mavarez-Martinez A, Israelyan LA, Soghomonyan S, Fiorda-Diaz J, Sandhu G, Shimansky VN, Ammirati M, Palettas M, Lubnin AY, Bergese SD (2020) The effects of patient positioning on the outcome during posterior cranial fossa and pineal region surgery. Front Surg 7:9CrossRefPubMedPubMedCentral
4.
go back to reference Kwee MM, Ho YH, Rozen WM (2015) The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg 100(2):292–303CrossRefPubMedPubMedCentral Kwee MM, Ho YH, Rozen WM (2015) The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg 100(2):292–303CrossRefPubMedPubMedCentral
5.
go back to reference Orliaguet GA, Hanafi M, Meyer PG, Blanot S, Jarreau MM, Bresson D, Zerah M, Carli PA (2001) Is the sitting or the prone position best for surgery for posterior fossa tumours in children? Paediatr Anaesth 11(5):541–547CrossRefPubMed Orliaguet GA, Hanafi M, Meyer PG, Blanot S, Jarreau MM, Bresson D, Zerah M, Carli PA (2001) Is the sitting or the prone position best for surgery for posterior fossa tumours in children? Paediatr Anaesth 11(5):541–547CrossRefPubMed
6.
go back to reference Tanriover N, Ulm AJ, Rhoton AL Jr, Yasuda A (2004) Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 101(3):484–498CrossRefPubMed Tanriover N, Ulm AJ, Rhoton AL Jr, Yasuda A (2004) Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 101(3):484–498CrossRefPubMed
8.
go back to reference Toescu SM, Samarth G, Layard Horsfall H, Issitt R, Margetts B, Phipps KP, Jeelani NU, Thompson DNP, Aquilina K (2020) Fourth ventricle tumors in children: complications and influence of surgical approach. J Neurosurg Pediatr 27(1):52–61CrossRefPubMed Toescu SM, Samarth G, Layard Horsfall H, Issitt R, Margetts B, Phipps KP, Jeelani NU, Thompson DNP, Aquilina K (2020) Fourth ventricle tumors in children: complications and influence of surgical approach. J Neurosurg Pediatr 27(1):52–61CrossRefPubMed
9.
go back to reference Deshmukh VR, Figueiredo EG, Deshmukh P, Crawford NR, Preul MC, Spetzler RF (2006) Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle. Neurosurgery 58(4 Suppl 2):ONS-202–206; discussion ONS-206–207 Deshmukh VR, Figueiredo EG, Deshmukh P, Crawford NR, Preul MC, Spetzler RF (2006) Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle. Neurosurgery 58(4 Suppl 2):ONS-202–206; discussion ONS-206–207
10.
go back to reference Winter F, Herta J, Niederle M, Furtner J, Rentenberger C, Hedrich C, Roessler K, Dorfer C (2022) Pushing the limits of the prone position in the intraoperative magnetic resonance suite. Oper Neurosurg (Hagerstown) 23(6):e353–e359CrossRefPubMed Winter F, Herta J, Niederle M, Furtner J, Rentenberger C, Hedrich C, Roessler K, Dorfer C (2022) Pushing the limits of the prone position in the intraoperative magnetic resonance suite. Oper Neurosurg (Hagerstown) 23(6):e353–e359CrossRefPubMed
11.
go back to reference Jean WC, Abdel Aziz KM, Keller JT, van Loveren HR (2003) Subtonsillar approach to the foramen of Luschka: an anatomic and clinical study. Neurosurgery 52(4):860–866 discussion 866 Jean WC, Abdel Aziz KM, Keller JT, van Loveren HR (2003) Subtonsillar approach to the foramen of Luschka: an anatomic and clinical study. Neurosurgery 52(4):860–866 discussion 866
12.
go back to reference Hermann EJ, Hatipoglu Majernik G, Scheinichen D, Al-Afif S, Heissler HE, Palmaers T, Krauss JK (2023) Resection of posterior fossa tumors in the semi-sitting position in children younger than 4 years of age. Childs Nerv Syst 39(1):159–167CrossRefPubMed Hermann EJ, Hatipoglu Majernik G, Scheinichen D, Al-Afif S, Heissler HE, Palmaers T, Krauss JK (2023) Resection of posterior fossa tumors in the semi-sitting position in children younger than 4 years of age. Childs Nerv Syst 39(1):159–167CrossRefPubMed
13.
go back to reference Teping F, Linsler S, Zemlin M, Oertel J (2021) The semisitting position in pediatric neurosurgery: pearls and pitfalls of a 10-year experience. J Neurosurg Pediatr 1–10 Teping F, Linsler S, Zemlin M, Oertel J (2021) The semisitting position in pediatric neurosurgery: pearls and pitfalls of a 10-year experience. J Neurosurg Pediatr 1–10
Metadata
Title
The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary?
Authors
Anna Cho
Maria Aliotti Lippolis
Johannes Herta
Muhammet Dogan
Cora Hedrich
Amedeo A. Azizi
Andreas Peyrl
Johannes Gojo
Thomas Czech
Christian Dorfer
Publication date
04-05-2024
Publisher
Springer Berlin Heidelberg
Keyword
CSF Drainage
Published in
Child's Nervous System / Issue 9/2024
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-024-06443-3

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