Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle

被引:68
作者
Deshmukh, VR [1 ]
Figueiredo, EG [1 ]
Deshmukh, P [1 ]
Crawford, NR [1 ]
Preul, MC [1 ]
Spetzler, RF [1 ]
机构
[1] St Josephs Hosp, Barrow Neurol Inst, Div Neurol Surg, Phoenix, AZ 85013 USA
关键词
fourth ventricle; telovelar approach; transvernnian approach;
D O I
10.1227/01.NEU.0000207373.26614.BF
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: To quantify the exposure to the fourth ventricle obtained with the telovelar and transvermian approaches. METHODS: The telovelar, with and without C1 posterior arch removal, and transvermian approaches were performed on six cadaveric heads. The area of surgical exposure was calculated from triangles formed by defined anatomic points. A robotic microscope was used to determine the "angle of approach" for the same points. RESULTS: The maximal allowable vertical angle of attack to the obex of the fourth ventricle was significantly greater with the telovelar approach than with the transvermian approach (P < 0.002), but there was no difference at the rostral fourth ventricle. The maximal allowable horizontal angle of attack at the level of the obex, Luschka, and rostral fourth ventricle was significantly greater with the telovelar than with the transvermian approach (P < 0.001). Removal of the C1 posterior arch with the telovelar approach significantly increased the vertical angle of approach to the obex (P < 0.001) and rostral aspect of the fourth ventricle (P = 0.005) compared with the telovelar alone. The telovelar approach with C1 arch removal offered a larger working area than the transvermian approach (P < 0.001). CONCLUSION: Except for the vertical angle to the rostral aspect of the fourth ventricle, the telovelar approach provides greater angle of exposure in all planes than the transvermian approach. Removal of the C1 posterior arch obviates this sole advantage of the transvermian approach. The telovelar approach offers a corridor through noneloquent arachnoid planes and a safe and capacious working environment.
引用
收藏
页码:202 / 206
页数:5
相关论文
共 10 条
[1]  
DANDY WE, 1969, BRAIN, P452
[2]  
Holmes G, 1922, LANCET, V1, P1177
[3]  
Holmes G, 1922, LANCET, V2, P59
[4]   Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study [J].
Jean, WC ;
Aziz, KMA ;
Keller, JT ;
van Loveren, HR .
NEUROSURGERY, 2003, 52 (04) :860-866
[5]   A STUDY OF SAFE ENTRY ZONES VIA THE FLOOR OF THE 4TH VENTRICLE FOR BRAIN-STEM LESIONS - REPORT OF 3 CASES [J].
KYOSHIMA, K ;
KOBAYASHI, S ;
GIBO, H ;
KUROYANAGI, T .
JOURNAL OF NEUROSURGERY, 1993, 78 (06) :987-993
[6]   MICROSURGICAL AND MAGNETIC-RESONANCE-IMAGING ANATOMY OF THE CEREBELLOMEDULLARY FISSURE AND ITS APPLICATION DURING 4TH VENTRICLE SURGERY [J].
MATSUSHIMA, T ;
FUKUI, M ;
INOUE, T ;
NATORI, Y ;
BABA, T ;
FUJII, K ;
LISTER, JR ;
RHOTON, AL .
NEUROSURGERY, 1992, 30 (03) :325-330
[7]   Telovelar approach to the fourth ventricle: microsurgical anatomy [J].
Mussi, ACM ;
Rhoton, AL .
JOURNAL OF NEUROSURGERY, 2000, 92 (05) :812-823
[8]   MUTENESS OF CEREBELLAR ORIGIN [J].
REKATE, HL ;
GRUBB, RL ;
ARAM, DM ;
HAHN, JF ;
RATCHESON, RA .
ARCHIVES OF NEUROLOGY, 1985, 42 (07) :697-698
[9]   Comparison of the transvermian and telovelar approaches to the fourth ventricle [J].
Tanriover, N ;
Ulm, AJ ;
Rhoton, AL ;
Yasuda, A .
JOURNAL OF NEUROSURGERY, 2004, 101 (03) :484-498
[10]   SURGICAL-MANAGEMENT OF BRAIN-STEM VASCULAR MALFORMATIONS [J].
WEIL, SM ;
TEW, JM .
ACTA NEUROCHIRURGICA, 1990, 105 (1-2) :14-23