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Child's Nervous System
Published in: Child's Nervous System 10/2009

01-10-2009 | Invited Paper

Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus

Authors: Kazuaki Shimoji, Masakazu Miyajima, Kostadin Karagiozov, Kenji Yatomi, Toshio Matsushima, Hajime Arai

Published in: Child's Nervous System | Issue 10/2009

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Abstract

Introduction

Within the existing consensus for the best management of pediatric infratentorial ependymomas (PIE), surgery is the most important stage, where complete removal should be the perfect aim, before complementing it with chemo- or radiotherapy. That, however, remains a challenge even for the most skillful surgeons because of the vicinity of important brainstem and cranial nerve structures involved and is particularly difficult in lateral extensions.

Materials and methods

The paper analyzes the current trends of PIE treatment with emphasis on resection difficulties created by lateral extensions. Anatomical analysis and clinical application of the cerebellomedullary fissure dissection has created specific approaches, providing safe route to the lateral recess and cerebellopontine area by dividing safely tenia and tonsils and biventer lobes retraction.

Discussion and conclusion

Bilateral and unilateral approaches have been developed. This approach prevents the damage of transvermian access and the resulting cerebellar mutism in some cases. Indications, technique and benefits of transcerebellomedullary fissure types of approaches are discussed.
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Metadata
Title
Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus
Authors
Kazuaki Shimoji
Masakazu Miyajima
Kostadin Karagiozov
Kenji Yatomi
Toshio Matsushima
Hajime Arai
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 10/2009
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-009-0835-5

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