The Experts below are selected from a list of 261 Experts worldwide ranked by ideXlab platform
Filippo Flavio Angileri - One of the best experts on this subject based on the ideXlab platform.
-
telovelar approach to Fourth Ventricle tumors highlights and limitations
World Neurosurgery, 2015Co-Authors: Francesco Tomasello, Alfredo Conti, Salvatore Cardali, Domenico La Torre, Filippo Flavio AngileriAbstract:Objective Fourth Ventricle tumors have been traditionally approached by opening the cerebellar vermis. The “telovelar” approach is an alternative approach performed through the cerebellomedullary fissure to gain access to the Fourth Ventricle, avoiding neural tissue damage. We describe our experience with this approach and predictive factors for the extent of resection (EOR) and for outcomes. Methods We retrospectively analyzed the data of patients who underwent resection of Fourth Ventricle lesions using a bilateral telovelar approach between June 1998 and June 2013. We evaluated EOR, clinical outcomes, complication rates, and postoperative cerebellar dysfunction. Univariate and multivariate analyses were performed to identify the predictive factors for EOR and outcomes. Results Forty-five patients were included in this series. Complete resection was obtained in 40 patients (88.9%). One patient (2.2%) had lower cranial nerve palsy and died 2 months after surgery. Two patients (4.5%) had persistent deficits of the sixth cranial nerve. Two patients (4.5%) developed shunt dependency. Brainstem attachment, tumor size >4 cm, and location in the rostral one third of the Ventricle were associated with a higher rate of subtotal resection and neurological worsening. Cerebellar mutism did not occur in any patient. Conclusions Exposure of the Fourth Ventricle was satisfactory in all of the patients, and the floor of the Fourth Ventricle could be visualized early and be protected. EOR and outcomes were satisfactory in 90% of patients, including those harboring large tumors or lesions attached to the lateral or superolateral recesses of the Ventricle. Deep rostral tumor attachment was the main limitation of the telovelar approach.
Albert L Rhoton - One of the best experts on this subject based on the ideXlab platform.
-
telovelar approach to the Fourth Ventricle microsurgical anatomy
Journal of Neurosurgery, 2000Co-Authors: Antonio C M Mussi, Albert L RhotonAbstract:Object. In the past, access to the Fourth Ventricle was obtained by splitting the vermis or removing part of the cerebellum. The purpose of this study was to examine the access to the Fourth Ventricle achieved by opening the tela choroidea and inferior medullary velum, the two thin sheets of tissue that form the lower half of the roof of the Fourth Ventricle, without incising or removing part of the cerebellum. Methods. Fifty formalin-fixed specimens, in which the arteries were perfused with red silicone and the veins with blue silicone, provided the material for this study. The dissections were performed in a stepwise manner to simulate the exposure that can be obtained by retracting the cerebellar tonsils and opening the tela choroidea and inferior medullary velum. Conclusions. Gently displacing the tonsils laterally exposes both the tela choroidea and the inferior medullary velum. Opening the tela provides access to the floor and body of the Ventricle from the aqueduct to the obex. The additional openi...
Laszlo Solymosi - One of the best experts on this subject based on the ideXlab platform.
-
central neurocytoma of the Fourth Ventricle
Journal of Neurosurgery, 1999Co-Authors: Monika Warmuthmetz, Rudiger Klein, N Sorensen, Laszlo SolymosiAbstract:✓ The authors report on a 17-year-old boy who suffered from slowly progressive and long-standing symptoms of ataxia, neck pain, and headache. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed a tumor arising from the floor of the Fourth Ventricle that resulted in a moderate hydrocephalus. A partial resection was performed. Histological and immunohistological findings led to the diagnosis of an atypical central neurocytoma of the Fourth Ventricle. The imaging features on CT scanning, MR imaging, and proton MR spectroscopy studies, the clinical picture, and the prognosis of this very unusual tumor are discussed. Three cases of neurocytomas in the posterior fossa have been described to date; however, in all three cases some atypical aspects were present. In the present case, with the exception of the very unusual location, both imaging findings and clinical history perfectly met the definition of this rare tumor.
Sanjay Misra - One of the best experts on this subject based on the ideXlab platform.
-
endoscopic treatment of the trapped Fourth Ventricle
Neurosurgery, 1999Co-Authors: Tim Burson, Sanjay MisraAbstract:OBJECTIVE: To propose endoscopic treatment as an effective initial alternative for patients with a trapped Fourth Ventricle. METHODS: We reviewed the records of the last 16 consecutive patients with a symptomatic trapped Fourth Ventricle seen at the Arkansas Children's Hospital. The first eight patients underwent a shunt procedure; the next eight had endoscopic procedures. The shunt procedures consisted of either separate shunts or combined supra- and infratentorial shunts with shared distal catheters. The endoscopic procedures consisted of either fenestration into the lateral Ventricle or aqueductal plasty with or without a stent. RESULTS: All patients underwent successful procedures with good outcomes, although the patients with shunts appeared to have a higher-than-expected rate of revision (50%). Seven revisions were performed on four patients, with a complication rate of 25%. Of the patients who had endoscopic procedures, one eventually required a shunt. The overall complication rate for patients who had endoscopic procedures was also 25%. CONCLUSION: Endoscopic treatment of the trapped Fourth Ventricle is effective in most cases. In view of the higher-than-expected revision rate with Fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped Fourth Ventricle.
Andrea Martinuzzi - One of the best experts on this subject based on the ideXlab platform.
-
endoscopic anatomy of the Fourth Ventricle
Journal of Neurosurgery, 2008Co-Authors: Pierluigi Longatti, Alessandro Fiorindi, Alberto Feletti, Domenico Davella, Andrea MartinuzziAbstract:Object Microsurgical anatomy of the Fourth Ventricle has been comprehensively addressed by masterly reports providing classic descriptions of this complex region. Neuroendoscopy could offer a new, somewhat different perspective of the “inside” view of the Fourth Ventricle. The purpose of this study was to examine from the anatomical point of view the access to the Fourth Ventricle achieved by the endoscopic transaqueductal approach, to enumerate and describe the anatomically identifiable landmarks, and to compare them with those described during microsurgery. Methods The video recordings of 52 of 75 endoscopic explorations of the Fourth Ventricle performed at the authors' institution for different pathological conditions were reviewed and evaluated to identify and describe every anatomical landmark. According to the microsurgical anatomy, at least 23 superficial structures are clearly identifiable in the Fourth Ventricle, and they represent the comparative basis of parallel endoscopic anatomy of the struc...
