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

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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.

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Authors and Affiliations

  1. Department of Neurosurgery, Juntendo Nerima Hospital, 3-1-10 Takanodai Nerima, Tokyo, 177-8521, Japan

    Kazuaki Shimoji

  2. Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo, Tokyo, 113-8421, Japan

    Masakazu Miyajima, Kostadin Karagiozov, Kenji Yatomi & Hajime Arai

  3. Department of Neurosurgery, Saga University School of Medicine, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan

    Toshio Matsushima

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  1. Kazuaki Shimoji
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  2. Masakazu Miyajima
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Correspondence to Hajime Arai.

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Shimoji, K., Miyajima, M., Karagiozov, K. et al. Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus. Childs Nerv Syst 25, 1221–1228 (2009). https://doi.org/10.1007/s00381-009-0835-5

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