Child's Nervous System

, Volume 25, Issue 10, pp 1221–1228

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

  • Kazuaki Shimoji
  • Masakazu Miyajima
  • Kostadin Karagiozov
  • Kenji Yatomi
  • Toshio Matsushima
  • Hajime Arai
Invited Paper

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.

Keywords

Ependymoma Fourth ventricle Cerebellomedullary fissure Childhood Brain tumor 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kazuaki Shimoji
    • 1
  • Masakazu Miyajima
    • 2
  • Kostadin Karagiozov
    • 2
  • Kenji Yatomi
    • 2
  • Toshio Matsushima
    • 3
  • Hajime Arai
    • 2
  1. 1.Department of NeurosurgeryJuntendo Nerima HospitalTokyoJapan
  2. 2.Department of NeurosurgeryJuntendo University School of MedicineTokyoJapan
  3. 3.Department of NeurosurgerySaga University School of MedicineSaga CityJapan

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