Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Borderless Research, Advancement, and Innovation in Neuroscience Network (BRIANet), Tehran, Iran.
Department of Neurosurgery, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Neurosurgical Research Network, Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Clin Neurol Neurosurg. 2024 May;240:108259. doi: 10.1016/j.clineuro.2024.108259. Epub 2024 Mar 26.
Tumors in the fourth ventricle can be critical due to the small size of the fourth ventricle, which causes symptoms to be detected even in the presence of lesser mass effects. A proper surgical approach to the fourth ventricle poses challenges due to its deep location and proximity to vital compartments within the brainstem. The two commonly used approaches to these tumors are the transvermian and telovelar approaches.
A comprehensive systematic study was conducted based on a literature search of the databases. All case controls, cohorts, and case series including patients with fourth ventricle tumors, who were operated on with either telovelar or transvermian approaches were considered eligible. The evaluated outcomes were comparative postoperative complications of the telovelar vs. transvermian approach. After screening and data extraction, a meta-analysis was performed whenever adequate quantitative data were available.
Seven studies with a total number of 848 patients, discussed both telovelar and transvermian approaches, with comparative reporting of outcomes in each group. Postoperative outcomes including cranial nerve deficit, mutism, diplopia, CSF leak, need for CSF diversion, and postoperative gait disturbance were not significantly different between telovelar and transvermian approaches.
Postoperative complications were not significantly different between telovelar and transvermian approaches. Moreover, it could be proposed that such complications would be more likely to be a multifactorial matter concerning the patient's clinical condition, tumor characteristics, and surgeon's experience, rather than the surgical approach alone.
由于第四脑室体积较小，即使肿瘤的占位效应较小，也可能导致症状被发现，因此第四脑室肿瘤可能很关键。由于第四脑室位置较深，靠近脑干内的重要结构，因此对其进行适当的手术入路颇具挑战性。针对这些肿瘤，两种常用的手术入路是经蚓部和经天幕入路。
我们基于文献数据库检索进行了全面的系统研究。所有病例对照、队列和病例系列研究，包括接受经天幕或经蚓部入路手术治疗的第四脑室肿瘤患者，均被认为符合入选标准。评估的结局是经天幕入路与经蚓部入路术后并发症的比较。在筛选和数据提取后，只要有足够的定量数据，就会进行荟萃分析。
共有 7 项研究，总计 848 例患者，讨论了经天幕和经蚓部入路，每组均有比较结果的报道。术后结果包括颅神经损伤、缄默症、复视、CSF 漏、需要 CSF 分流以及术后步态障碍，在经天幕入路和经蚓部入路之间无显著差异。
经天幕入路和经蚓部入路的术后并发症无显著差异。此外，可以提出这样的观点，即这些并发症更可能是一个多因素问题，涉及患者的临床状况、肿瘤特征和外科医生的经验，而不仅仅是手术入路本身。
