nach oben

Child's Nervous System

Erschienen in:

01.10.2009 | Invited Paper

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

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

Erschienen in: Child's Nervous System | Ausgabe 10/2009

Einloggen, um Zugang zu erhalten

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.

Barone B, Elvidge A (1970) Ependymomas. A clinical study. J Neurosurg 33:428–438PubMedCrossRef

Bastian AJ, Mink JW, Kaufman BA (1998) Posterior vermian split syndrome. Ann Neurol 44:601–610PubMedCrossRef

Copeland DR, deMoor C, Moore BD 3rd, Ater JL (1999) Neurocognitive development of children after a cerebellar tumor in infancy: a longitudinal study. J Clin Oncol 17:3476–3486PubMed

Coulon R, Till K (1977) Intracranial ependymomas in children: a review of 43 cases. Childs Brain 3:154–168PubMed

Cully D, Berger M, Shaw D, Geyer R (1994) An analysis of factors determining the need for ventriculoperitoneal shunts following posterior fossa tumor surgery in children. Neurosurgery 34:402–408

Dailey AT, McKhann GMII, Berger MS (1995) The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg 83:467–475PubMedCrossRef

Dietze DD Jr, Mickle JP (1990/1991) Cerebellar mutism after posterior fossa surgery. Pediatr Neurosurg 16:25–31CrossRef

Dohrmann GJ (1996) Ependymomas. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, 2nd edn. McGraw-Hill, New York, pp 1195–1200

Duffner PK, Krischer JP, Horowitz ME, Cohen ME, Burger PC, Friedman HS, Kun LE (1998) Second malignancies in young children with primary brain tumors following treatment with prolonged postoperative chemotherapy and delayed irradiation: a Pediatric Oncology Group study. Ann Neurol 44:313–316PubMedCrossRef

10.

El-Bahy K (2005) Telovelar approach to the fourth ventricle: operative findings and results in 16 cases. Acta Neurochir (Wien) 147:137–142CrossRef

11.

Figarella-Branger D, Civatte M, Bouvier-Labit C, Gouvernet J, Gambarelli D, Gentet JC, Lena G, Choux M, Pellissier JF (2000) Prognostic factor in intracranial ependymomas in children. J Neurosurg 93:605–613PubMedCrossRef

12.

Ferrante L, Mastronardi L, Acqui M, Fortuna A (1990) Mutism after posterior fossa surgery in children. Report of three cases. J Neurosurg 72:959–963PubMedCrossRef

13.

Fokes E, Earle K (1969) Ependymomas: clinical and pathological aspects. J Neurosurg 30:585–594PubMedCrossRef

14.

Gelabert-González M, Fernández-Villa J (2001) Mutism after posterior fossa surgery. Review of the literature. Clin Neurol Neurosurg 103:111–114PubMedCrossRef

15.

Geyer JR, Zeltzer PM, Boyett JM, Rorke LB, Stanley P, Albright AL, Wisoff JH, Milstein JM, Allen JC, Finlay JL, Ayers GD, Shurin SB, Stevens KR, Bleyer WA (1994) Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the children’s cancer group. J Clin Oncol 12:1607–1615PubMed

16.

Gök A, Alptekin M, Erkutlu T (2004) Surgical approach to the fourth ventricle cavity through the cerebellomedullary fissure. Neurosurg rev 27:50–54PubMedCrossRef

17.

Grundy RG, Wilne SA, Weston CL, Robinson K, Lashford LS, Ironside J, Cox T, Chong WK, Campbell RHA, Bailey CC, Gattamaneni R, Picton S, Thorpe N, Mallucci C, English MW, Punt JAG, Walker DA, Ellison DW, Machin D, for the Children’s Cancer and Leukaemia Group (formerly UKCCSG) Brain Tumour Committee (2007) Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study. Lancet Oncol 8:696–705PubMedCrossRef

18.

Healey EA, Barnes PD, Kupsky WJ, Scott RM, Sallan SE, Black PM, Tarbell NJ (1991) The prognostic significance of postoperative residual tumor in ependymoma. Neurosurgery 28:666–672PubMedCrossRef

19.

Horn B, Heideman R, Geyer R, Pollack I, Packer R, Goldwein J, Tomita T, Schomberg P, Ater J, Luchtman-Jones L, Rivlin K, Lamborn K, Prados M, Bollen A, Berger M, Dahl G, Mcneil E, Patterson K, Shaw D, Kubalik M, Russo C (1999) A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol 21:203–211PubMedCrossRef

20.

Ikezaki K, Matsushima T, Yokoyama N, Kaneko Y, Fukui M (1993) Correlation of microanatomical localization with postoperative survival in posterior fossa ependymomas. Neurosurgery 32:38–44PubMedCrossRef

21.

Inoue T, Matsushima T, Inamura T, Kawamura T, Ishihara S, Fukui M (1998) Surgical approach to the mesencephalic vascular malformation-transcerebellomedullary fissure approach. Surg Cereb Stroke 26:287–291

22.

Kellogg JX, Piatt JH Jr (1997) Resection of the fourth ventricle tumors without splitting the vermis: the cerebbelomedullary fissure approach. Pediatr Neurosurg 27:28–33PubMedCrossRef

23.

Kobayashi S, Sugita K, Tanaka Y, Kyoshima K (1983) Infratentorial approach to the pineal region in the prone position: concord position. Technical note. J Neurosurg 58:141–143PubMedCrossRef

24.

Lannering B, Marky I, Lundberg A, Olsson E (1990) Long-term sequelae after pediatric brain tumors: their effect on disability and quality of life. Med Pediatr Oncol 18:304–310PubMedCrossRef

25.

Louis DN, Ohgaki H, Weistler OD, Cavenee WK (2007) World Health Organization classification of tumours of the central nervous system Chapter 3 : Ependymal tumours Pp 69-80 IARC, Lyon

26.

Matsushima T, Inoue T, Inamura T, Natori Y, Ikezaki K, Fukui M (2001) Transcerebellomedullary fissure approach with special reference to methods of dissecting the fissure. J Neurosurg 94:257–264PubMedCrossRef

27.

Matsushima T, Ikezaki K, Inoue T (1998) Surgery of ependymomas in the fourth ventricle. In: Shibata S (ed) Surgery of glioma. Medica Suita City pp 54-62

28.

Matsushima T, Fukui M, Inoue T, Natori Y, Baba T, Fujii K (1992) Microsurgical and magnetic resonance imaging anatomy of the cerebellomedullary fissure and its application during fourth ventricle surgery. Neurosurgery 30:325–330PubMedCrossRef

29.

Matsushima T, Fukui M, Rhoton AL Jr (1989) Microsurgical anatomy of the fourth ventricle- special reference to the suboccipital midline approach. In: Kobayashi S (ed) Surgical anatomy for microneurosurgery II. SciMed, Tokyo pp 198-211

30.

Matsushima T, Rhoton AL Jr, Lenkey C (1982) Microsurgery of the fourth ventricle. Part I: Microsurgical anatomy. Neurosurgery 11:631–667PubMedCrossRef

31.

Merchant TE, Fouladi M (2005) Ependymoma: new therapeutic approaches including radiation and chemotherapy. J Neurooncol 75:287–299PubMedCrossRef

32.

Mork S, Loken A (1977) Ependymoma. A follow-up study of 101 cases. Cancer 40:907–915PubMedCrossRef

33.

Morota N, Deletis V, Epstein FJ, Kofler M, Abbott R, Lee M, Ruskin K (1995) Brain stem mapping: neurophysiological localization of motor nuclei on the floor of the fourth ventricle. Neurosurgery 37:922–930PubMedCrossRef

34.

Morota N, Deletis V, Lee M, Epstein FJ (1996) Functional anatomic relationship between brain stem tumors and cranial motor nuclei. Neurosurgery 39:787–794PubMedCrossRef

35.

Morota N, Deletis V, Epstein FJ (2002) Brainstem mapping. In: Deletis V, Shils JL (eds) Neurophysiology in neurosurgery. Academic, New York, pp 319–335CrossRef

36.

Morota N, Deletis V (2006) The importance of brainstem mapping in brainstem surgical anatomy before the fourth ventricle and implication for intraoperative neurophysiological mapping. Acta Neurochir (Wien) 148:499–509CrossRef

37.

Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE (2004) Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol 5:399–408PubMedCrossRef

38.

Mussi ALM, Rhoton AL Jr (2000) Telovelar approach to the fourth ventricle: microsurgical anatomy. J Neurosurg 92:812–823PubMedCrossRef

39.

Nagib MG, O’fallon MT (1996) Posterior fossa lateral ependymoma in childhood. Pediatr Neurosurg 24:299–305PubMedCrossRef

40.

Nazar GB, Hoffman HJ, Becker LE, Jenkin D, Humphreys RP, Hendrick EB (1990) Infratentorial ependymomas in childhood: prognostic factors and treatment. J Neurosurg 72:408–417PubMedCrossRef

41.

Oya N, Shibamoto Y, Nagata Y, Negoro Y, Hiraoka M (2002) Postoperative radiotherapy for intracranial ependymoma : analysis of prognostic factors and patterns of failure. J Neurooncol 56:87–94PubMedCrossRef

42.

Palma L, Celli P, Mariottini A, Cantore G (1993) Supratentorial ependymomas of the first two decades of life. Long-term follow-up of 20cases (including two subependymomas). Neurosurgery 32:169–175PubMedCrossRef

43.

Pierre-Kahn A, Hirsch JF, Roux FX, Renier D, Sainte-Rose C (1983) Intracranial ependymomas in childhood. Survival and functional results of 47 cases. Childs Brain 10:145–156PubMed

44.

Pollak IF, Polinko P, Albright AL, Towbin R, Fitz C (1995) Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: Incidence and pathophysiology. Neurosurgery 37:885–893

45.

Pollack IF, Gersten PC, Martinez AJ, Lo KH, Shultz B, Albright AL, Janosky J, Deutsch M (1995) Intracranial ependymoma of childhood: long-term outcome and prognostic factors. Neurosurgery 37:655–666, discussion 666-667PubMedCrossRef

46.

Raimondi AJ, Tomita T (1981) Hydrocephalus and infratentorial tumors: Incidence, clinical picture and treatment. J Neurosurg 55:174–182PubMedCrossRef

47.

Rhoton AL Jr (2000) Cerebellum and fourth ventricle. Neurosurgery 47([Suppl]):7–27CrossRef

48.

Riva D, Giorgi C (2000) The neurodevelopmental price of survival in children with malignant brain tumours. Childs Nerv Syst 16:751–754PubMedCrossRef

49.

Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, Diaz MS, Allen JC (2006) Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology Group. J Neurosurg 105(6 Suppl Pediatrics):444–451PubMed

50.

Sala F, Talacchi A, Mazza C, Prisco R, Ghimenton C, Bricolo A (1998) Prognostic factors in childhood intracranial ependymomas: the role of age and tumor location. Pediatr Neurosurg 28:135–142PubMedCrossRef

51.

Siffert J, Poussaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, Pomeroy SL (2000) Neurological dysfunction associated with postoperative cerebellar mutism. J Neurooncol 48:75–81PubMedCrossRef

52.

Smyth MD, Horn BN, Russo C, Berger MS (2000) Intracranial ependymomas of childhood: current management strategies. Pediatr Neurosurg 33:138–150PubMedCrossRef

53.

Spangnoli D, Tomei G, Ceccarelli G, Grimoldi N, Lanterna A, Bello L, Sinisi MM, Santis AD, Villani RM (2000) Combined treatment of fourth ventricle ependymomas: report of 26 cases. Surg Neurol 54:19–26CrossRef

54.

Spiegler BJ, Bouffet E, Greenberg ML, Rutka JT, Mabbott DJ (2004) Change in neurocognitive functioning after treatment with cranial radiation in childhood. J Clin Oncol 22:706–713PubMedCrossRef

55.

Spoudeas H, Kirkham F (2004) Toxicity and late effects. In: Walker DA, Perilongo G, Punt JAG, Taylor RE (eds) Brain and spine tumours of childhood. Arnold, London, pp 433–462

56.

Strauss C, Romstock J, Nimsky C, Fahlbusch R (1993) Intraoperative identification of motor areas of the rhomboid fossa using direct stimulation. J Neurosurg 79:393–399PubMedCrossRef

57.

Strauss C, Romstock J, Fahlbusch R (1999) Pericollicular approaches to the rhomboid fossa. Part II. Neurophysiological basis. J Neurosurg 91:768–775

58.

Sutton LN, Goldwein J, Perilongo G, Lang B, Schut L, Rorke L, Packer R (1990–1991) Prognostic factor in childhood ependymomas. Pediatric Neurosurg 16:57–65CrossRef

59.

Teo C, Nakaji P, Symons P, Tobias V, Cohn R, Smee R (2003) Ependymoma. Childs Nerv Syst 9:270–285CrossRef

60.

Tomita T (2001) Ependymomas. In: Mclone DG (ed) Pediatric neurosurgery, 4th edn. Saunders, Philadelphia, pp 822–834

61.

Tomita T, Rosenblatt SS (1991) Management of hydrocephalus secondary to posterior fossa tumor in childhood. In: Matsumoto S, Tamaki N (eds) Hydrocephalus-pathogenesis and treatment. Springer, New York, pp 306–310

62.

Van Callenberg F, De Laar AY, Plets C, Goffin J, Ceasar P (1995) Transient cerebellar mutism after posterior fossa surgery in children. Neurosurgery 37:894–898

63.

Van Dongen HR, Catsman-Berrevoets CE, van Mourik M (1994) The syndrome of ‘cerebellar’ mutism and subsequent dysarthria. Neurology 44:2040–2046PubMed

64.

Winston KR (2001) Surgery for tumors in the posterior cranial fossa. In: Mclone DG (ed) Pediatric neurosurgery, 4th edn. Saunders, Philadelphia, pp 844–854

65.

Ziyal IM, Sekhar LN, Salas E (1999) Subtonsillar-transcerebellomedullaty approach to lesions involving the fourth ventricle, the cerebellomedullary fissure and the lateral brainstem. Br J Neurosurg 13:276–284PubMedCrossRef

Titel: Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus
verfasst von: Kazuaki Shimoji
Masakazu Miyajima
Kostadin Karagiozov
Kenji Yatomi
Toshio Matsushima
Hajime Arai
Publikationsdatum: 01.10.2009
Verlag: Springer-Verlag
Erschienen in: Child's Nervous System / Ausgabe 10/2009
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-009-0835-5

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

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