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


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.


CONCLUSIONS
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.
Shimoji
Kazuaki
K
Department of Neurosurgery, Juntendo Nerima Hospital, 3-1-10 Takanodai Nerima, Tokyo, 177-8521, Japan.
Miyajima
Masakazu
M
Karagiozov
Kostadin
K
Yatomi
Kenji
K
Matsushima
Toshio
T
Arai
Hajime
H
D000293:Adolescent; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002531:Cerebellum / Q000473:pathology / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D004806:Ependymoma / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome