Telovelar approach for surgical treatment of fourth ventricle tumors in adult patients

Abstract

Purpose: Surgery in and around the fourth ventricle is challenging not only because it has a central location in the Central Nervous System (CNS) but also because it lies in such close proximity to multiple vital structures. Treatment of tumors in this area has nevertheless evolved significantly; with the telovelar, as the most widely used surgical approach today. The aim of this paper is to evaluate results of the telovelar approach for surgical treatment of fourth ventricular tumors, as well as describe the technique. Materials and Methods: A retrospective study was conducted of adult patients undergoing surgery for tumors of the fourth ventricle, between 2011 and 2019 at our institution, using a telovelar approach. Demographic and clinical data were collected together with pre and postoperative test results, operative reports and videos. The Karnofsky Performance Status (KPS) scale was used to measure clinical outcome. Results: During an 8-year period, 18 adult patients with fourth ventricle tumors were operated using the telovelar approach. The most frequent presenting symptom was headache (50%), and the most common pathology reported ependymoma. Gross total resection (GTR) was achieved in 67% of cases and average immediate postoperative KPS score was 86.1, improving slightly during follow-up. Conclusion: Fourth ventricle tumors are relatively uncommon in the adult population. Current treatment continues to be surgical excision and the approach of choice is the telovelar. We present details of the technique together with results of this case series.