The Experts below are selected from a list of 1989 Experts worldwide ranked by ideXlab platform
R S Lаkotko - One of the best experts on this subject based on the ideXlab platform.
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surgical resection of fourth ventricular tumors comparison of the efficiency and safety of telovelar and Median Aperture approaches to the fourth ventricle
Russian journal of neurosurgery, 2019Co-Authors: K N Babichev, A V Stanishevskiy, D V Svistov, D A Averyanov, R S LаkotkoAbstract:The s tudy objective is to compare the efficacy and safety of the fourth ventricle tumor removal using Median (through the Median Aperture) or telovelar approach. Materials and methods. The analysis included 41 patients with space-occupying lesion of the fourth ventricle operated in the Neurosurgery Clinic of S.M. Kirov Military Medical Academy in 2007–2018. The anatomical characteristics (size and extension) and manifestations of the fourth ventricle tumors, as well as surgical factors (surgical approach to the fourth ventricle) which affect the functional outcome of the treatment were estimated. Complications associated with the approach were assessed clinically using diffusion-weighted magnetic resonance imaging. Logistic regression and ROC analysis were used to analyze the anatomical factors and extent of resection as predictors that affect the worsening of gait disturbance, speech/swallowing deficits in the postoperative period. Results. The analysis revealed main advantages of the Median approach in comparison to the telovelar approach: a lower frequency of C laminectomy; no need for prolonged constant tonsillar retraction; a shorter surgery duration and lower number of ischemic changes in the surgical area, caused by approach. Meanwhile the telovelar approach was used to remove lesions bigger in size. Other factors, such as tumor extension, the need to preliminary insertion of an external ventricular drain, the frequency of postoperative complications, the extent of resection and the functional outcomes did not differ significantly between the approaches. Lesion size ≥37.5 mm is a significant prognostic factor for speech/swallowing deficits after the surgery with sensitivity of 86 % and specificity of 84 %. Conclusion. Median Aperture approach is a reasonable alternative to telovelar or transvermian approaches in the surgery of small fourth ventricle tumors (<30 mm). The Median approach allows to reduce the surgical injury rate and the likelihood of postoperative complications. If a lesion has a size ≥37.5 mm, an increase speech/swallowing deficits should be expected.
K N Babichev - One of the best experts on this subject based on the ideXlab platform.
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surgical resection of fourth ventricular tumors comparison of the efficiency and safety of telovelar and Median Aperture approaches to the fourth ventricle
Russian journal of neurosurgery, 2019Co-Authors: K N Babichev, A V Stanishevskiy, D V Svistov, D A Averyanov, R S LаkotkoAbstract:The s tudy objective is to compare the efficacy and safety of the fourth ventricle tumor removal using Median (through the Median Aperture) or telovelar approach. Materials and methods. The analysis included 41 patients with space-occupying lesion of the fourth ventricle operated in the Neurosurgery Clinic of S.M. Kirov Military Medical Academy in 2007–2018. The anatomical characteristics (size and extension) and manifestations of the fourth ventricle tumors, as well as surgical factors (surgical approach to the fourth ventricle) which affect the functional outcome of the treatment were estimated. Complications associated with the approach were assessed clinically using diffusion-weighted magnetic resonance imaging. Logistic regression and ROC analysis were used to analyze the anatomical factors and extent of resection as predictors that affect the worsening of gait disturbance, speech/swallowing deficits in the postoperative period. Results. The analysis revealed main advantages of the Median approach in comparison to the telovelar approach: a lower frequency of C laminectomy; no need for prolonged constant tonsillar retraction; a shorter surgery duration and lower number of ischemic changes in the surgical area, caused by approach. Meanwhile the telovelar approach was used to remove lesions bigger in size. Other factors, such as tumor extension, the need to preliminary insertion of an external ventricular drain, the frequency of postoperative complications, the extent of resection and the functional outcomes did not differ significantly between the approaches. Lesion size ≥37.5 mm is a significant prognostic factor for speech/swallowing deficits after the surgery with sensitivity of 86 % and specificity of 84 %. Conclusion. Median Aperture approach is a reasonable alternative to telovelar or transvermian approaches in the surgery of small fourth ventricle tumors (<30 mm). The Median approach allows to reduce the surgical injury rate and the likelihood of postoperative complications. If a lesion has a size ≥37.5 mm, an increase speech/swallowing deficits should be expected.
Gabriel Zada - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic assisted craniotomy for resection of fourth ventricular lesions and confirmation of aqueductal patency via a suboccipital Median Aperture approach
Journal of Clinical Neuroscience, 2020Co-Authors: Ali R. Tafreshi, Daniel A. Donoho, Martin J. Rutkowski, Gabriel ZadaAbstract:Abstract Adequate exposure to fourth ventricular (4V) lesions located adjacent to the cerebral aqueduct and superior medullary velum often mandates extensive telovelar dissection. We assessed the utility of endoscopic assistance via a Median Aperture approach during suboccipital resection of 4V lesions. We retrospectively reviewed a series of nine patients who underwent suboccipital resection of a 4V lesion via an endoscopic-assisted Median Aperture approach from 2011 to 2018. Our series included the following pathology: ependymoma (2), rosette-forming glioneuronal tumors (2), pilocytic astrocytoma (1), metastatic melanoma (1), epidermoid cyst (1), organized hematoma (1), and neurocysticercosis (1). Preoperative symptoms included headache (n = 8, 88.9%), nausea (n = 5, 55.6%), vomiting, dizziness, and gait disturbance (n = 4 each, 44.5%). In four cases, the endoscope was used for the majority of the resection or to resect additional tumor located rostrally in the 4V following maximal microscopic resection. In five patients, it was used to confirm extent of resection and patency of the cerebral aqueduct. Gross total resection was achieved in five patients (55.6%). No postoperative complications were attributed to use of the endoscope for additional resection. No patients required immediate CSF diversion, and one patient underwent ventriculoperitoneal (VP) shunt insertion over one year after initial biopsy/fenestration due to tumor progression. Our series is the first to demonstrate the utility of angled endoscopic assistance via a Median Aperture approach during microsurgical approaches for a variety of 4V lesions. Confirmation of patency of the cerebral aqueduct may help avoid requirements for CSF diversion.
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Endoscopic-Assisted Median Aperture Approach for Resection of Fourth Ventricular Tumor and Confirmation of Patency of Cerebral Aqueduct Using an Adjustable-Angle Endoscope: Technical Case Report.
Operative Neurosurgery, 2017Co-Authors: Ryan J. Austerman, Joshua Lucas, Alexandra Kammen, Gabriel ZadaAbstract:BACKGROUND AND IMPORTANCE Open microsurgical approaches to the roof of the fourth ventricle via a telovelar approach typically require cerebellar retraction and/or splitting of the vermis and may be associated with postoperative neurological morbidities. In this case report and technical note, we describe the use of an adjustable-angle endoscope inserted into the Median Aperture via suboccipital craniotomy, resulting in enhanced visualization of the roof of the fourth ventricle and cerebral aqueduct and maximal safe tumor resection. CLINICAL PRESENTATION A 49-yr-old woman with obstructive hydrocephalus and a fourth ventricular mass that was not fully visible with the use of an operative microscope. CONCLUSION Direct visualization of the roof of the fourth ventricle, including the superior medullary velum and cerebral aqueduct, can be facilitated with an adjustable angle endoscope inserted into the Median Aperture via suboccipital craniotomy to minimize the degree of telovelar dissection and vermis splitting.
W. Jerry Oakes - One of the best experts on this subject based on the ideXlab platform.
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Arachnoid veils and the Chiari I malformation.
Journal of Neurosurgery, 2004Co-Authors: R. Shane Tubbs, Matthew D. Smyth, John C. Wellons, W. Jerry OakesAbstract:Object. The literature contains scant data regarding variations in anatomy at the level of the foramen of Magendie in patients with Chiari I malformation and syringomyelia. Methods. Based on their operative experience and hospital data, the authors detailed the incidence of arachnoid veils found in juxtaposition to the foramen of Magendie in patients with hindbrain herniation. Additionally, radiological studies were retrospectively reviewed in cases in which such an anomaly was noted intraoperatively. Of 140 patients with Chiari I malformation who underwent decompressive surgery, an associated syrinx was demonstrated in 80 (57%). The foramen of Magendie was obstructed by an arachnoid veil in 10 (12.5%) of these patients; once the lesion was punctured, the cerebrospinal fluid drained freely from this Median Aperture. On retrospective review of imaging studies, none of these anomalous structures was evident. In all patients with an arachnoid veil and syringomyelia resolution of syringomyelia was revealed on...
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Arachnoid veils and the Chiari I malformation.
Journal of neurosurgery, 2004Co-Authors: R. Shane Tubbs, Matthew D. Smyth, John C. Wellons, W. Jerry OakesAbstract:The literature contains scant data regarding variations in anatomy at the level of the foramen of Magendie in patients with Chiari I malformation and syringomyelia. Based on their operative experience and hospital data, the authors detailed the incidence of arachnoid veils found in juxtaposition to the foramen of Magendie in patients with hindbrain herniation. Additionally, radiological studies were retrospectively reviewed in cases in which such an anomaly was noted intraoperatively. Of 140 patients with Chiari I malformation who underwent decompressive surgery, an associated syrinx was demonstrated in 80 (57%). The foramen of Magendie was obstructed by an arachnoid veil in 10 (12.5%) of these patients; once the lesion was punctured, the cerebrospinal fluid drained freely from this Median Aperture. On retrospective review of imaging studies, none of these anomalous structures was evident. In all patients with an arachnoid veil and syringomyelia resolution of syringomyelia was revealed on postoperative imaging. In the absence of a clear pathophysiology of syrinx production, the authors would recommend that patients with syringomyelia and Chiari I malformation undergo duraplasty so that, if present, these veils can be fenestrated.
D A Averyanov - One of the best experts on this subject based on the ideXlab platform.
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surgical resection of fourth ventricular tumors comparison of the efficiency and safety of telovelar and Median Aperture approaches to the fourth ventricle
Russian journal of neurosurgery, 2019Co-Authors: K N Babichev, A V Stanishevskiy, D V Svistov, D A Averyanov, R S LаkotkoAbstract:The s tudy objective is to compare the efficacy and safety of the fourth ventricle tumor removal using Median (through the Median Aperture) or telovelar approach. Materials and methods. The analysis included 41 patients with space-occupying lesion of the fourth ventricle operated in the Neurosurgery Clinic of S.M. Kirov Military Medical Academy in 2007–2018. The anatomical characteristics (size and extension) and manifestations of the fourth ventricle tumors, as well as surgical factors (surgical approach to the fourth ventricle) which affect the functional outcome of the treatment were estimated. Complications associated with the approach were assessed clinically using diffusion-weighted magnetic resonance imaging. Logistic regression and ROC analysis were used to analyze the anatomical factors and extent of resection as predictors that affect the worsening of gait disturbance, speech/swallowing deficits in the postoperative period. Results. The analysis revealed main advantages of the Median approach in comparison to the telovelar approach: a lower frequency of C laminectomy; no need for prolonged constant tonsillar retraction; a shorter surgery duration and lower number of ischemic changes in the surgical area, caused by approach. Meanwhile the telovelar approach was used to remove lesions bigger in size. Other factors, such as tumor extension, the need to preliminary insertion of an external ventricular drain, the frequency of postoperative complications, the extent of resection and the functional outcomes did not differ significantly between the approaches. Lesion size ≥37.5 mm is a significant prognostic factor for speech/swallowing deficits after the surgery with sensitivity of 86 % and specificity of 84 %. Conclusion. Median Aperture approach is a reasonable alternative to telovelar or transvermian approaches in the surgery of small fourth ventricle tumors (<30 mm). The Median approach allows to reduce the surgical injury rate and the likelihood of postoperative complications. If a lesion has a size ≥37.5 mm, an increase speech/swallowing deficits should be expected.