Abstract
Objective
Surgical exposure of intrinsic lesions located lateral to the brainstem still represents a challenging task. The aim of this study was to assess the feasibility of the extracerebral far lateral supracerebellar infratentorial (FLSI) approach for the treatment of gliomas located in the upper brainstem in the pediatric population.
Methods and results
Between 1992 and 2002, seven patients (mean age 8.7 years) with tumors of glial origin (WHO I–IV) located mainly in the pontomesencephalic region were operated with the FLSI approach in a sitting position. Satisfactory extent of resection without additional morbidity was achieved.
Conclusion
In a carefully selected pediatric patient population, the FLSI approach proved to be a feasible and effective surgical route for the treatment of upper brainstem gliomas.
Similar content being viewed by others
References
Ammirati M, Bernardo A, Musumeci A et al (2002) Comparison of different infratentorial–supracerebellar approaches to the posterior and middle incisural space: a cadaveric study. Neurosurgery 97:922–928
Ammirati M, Musumeci A, Bernardo A et al (2002) The microsurgical anatomy of the cisternal segment of the trochlear nerve, as seen through different neurosurgical operative windows. Acta Neurochir 144:1323–1327
Bricolo A (2000) Surgical management of intrinsic brain stem gliomas. Op Tech Neurosurg 3:137–154
Daspit CP, Spetzler RF, Pappas CT (1991) Combined approach for lesions involving the cerebellopontine angle and the skull base: experience with 20 cases—preliminary report. Otolaryngol Head Neck Surg 105:788–796
Epstein F, McCleary EL (1986) Intrinsic brain-stem tumors of childhood: surgical indications. J Neurosurg 64:11–15
Herrmann H-D, Winkler D, Westphal M (1992) Treatment of tumors of the pineal region and posterior part of the third ventricle. Acta Neurochir 116:137–146
Konovalov AN, Pitskhelauri DI (2001) Infratentorial supracerebellar approach to the colloid cysts of the third ventricle. Neurosurgery 49:1116–1123
Laborde G, Gilsbach JM, Harders A et al (1992) Experience with the infratentorial supracerebellar approach in lesions of the quadrigeminal region, posterior third ventricle, culmen cerebelli, and cerebellar peduncle. Acta Neurochir 114:135–138
Matsushima T, Fukui M, Suzuki S et al (1989) The microsurgical anatomy of the infratentorial lateral supracerebellar approach to the trigeminal nerve for Tic Douloureux. Neurosurgery 24:890–895
Ogata N, Yonekawa Y (1997) Paramedian supracerebellar approach to the upper brain stem and peduncular lesions. Neurosurgery 40:101–105
Pollack IF, Hoffman HJ, Humphreys RP, Becher L (1993) The long term outcome after surgical treatment of dorsally exophytic brain stem gliomas. J Neurosurg 78:859–863
Samii M, Carvalho GA, Tatagiba M et al (1996) Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84:375–381
Spetzler RF, Daspit CP, Pappas CTE (1992) The combined supra- and infratetorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76:588–599
Türe U, Ozduman K, Elmaci I et al (2002) Infratentorial lateral supracerebellar approach for trochlear nerve schwannoma. J Clin Neurosci 9:595–598
Vishteh GA, David CA, Marciano FF et al (2000) Extreme lateral supracerebellar infratentorial approach to the posterolateral mesencephalon: technique and clinical experience. Neurosurgery 46:384–389
Wang C, Zhang J, Liu A et al (2000) Surgical treatment of primary midbrain gliomas. Surg Neurol 53:41–51
Acknowledgements
We would like to express our gratitude to Professor Wolfgang Seeger for his excellent illustrations. We would also like to thank Professor Martin Schumacher, Section of Neuroradiology, University of Freiburg for the MRI pictures.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vougioukas, V.I., Omran, H., Gläsker, S. et al. Far lateral supracerebellar infratentorial approach for the treatment of upper brainstem gliomas: clinical experience with pediatric patients. Childs Nerv Syst 21, 1037–1041 (2005). https://doi.org/10.1007/s00381-005-1140-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-005-1140-6