Pitskhelauri David, Konovalov Alexander, Danilov Gleb, Bykanov Andrey, Pronin Igor, Kudieva Elina, Sanikidze Alexander, Lapteva Kristina, Melnikova-Pitskhelauri Tatiana
Department of Glial Tumors, Burdenko Neurosurgery Center, 16, 4th Tverskaya-Yamskaya St, Moscow, Russia.
Laboratory of Biomedical Informatics and Artificial Intelligence, Burdenko Neurosurgery Center, Moscow, Russia.
Neurosurg Rev. 2025 Aug 14;48(1):601. doi: 10.1007/s10143-025-03755-z.
Traditional transvermian (TvA) and telovelar approaches (TelA) for accessing tumors of the fourth ventricle (FV) are associated with the need to dissect the cerebellar vermis or with traction and dissection of the uvulotonsilar fissure, which often leads to postoperative cerebellar disorders. A surgical approach to the fourth ventricle (59 patients) and the brainstem (18 patients) through the foramen of Magendie utilizing a low angle of surgical attack is proposed. Depending on their localization, the tumors were divided into 4 main groups: 1) upper region, 8 cases; 2) middle region, 14 cases; 3) lower region, 20 cases; and 4) tumors of the lower region of the fourth ventricle with extension into the cisterna magna, 12 cases; and various combinations of these localizations, 23 cases. All surgeries were performed using minimally invasive techniques with a 4 cm soft tissue incision and 0-21 mm of occipital bone resection (median of 12 mm). Total tumor resection was achieved in 55 (71.4%; 95% CI [60%, 81%]) patients, including 48 (81.4%; 95% CI [69%, 90%]) with fourth-ventricle tumors and 7 (41.2%; 95% CI [18%, 64%]) with brainstem tumors (p <.001). Among fourth-ventricle tumors, the extent of tumor resection decreased depending on the tumor localization level (p = 0.05). Postoperative cerebellar disorders manifested or deteriorated significantly rarely, with tumors located at the upper levels of the fourth ventricle or brainstem (p=0.05), as well as with smaller dorsoventral tumor sizes (p=.004). The low-angle trans-Magendie foraminal approach is an effective technique for the surgical treatment of space-occupying lesions of the fourth ventricle and dorsal brainstem.
传统的经蚓部（TvA）和经小脑幕切迹 approach（TelA）入路用于切除第四脑室（FV）肿瘤时，需要解剖小脑蚓部，或牵拉和解剖小舌扁桃体裂，这常常导致术后小脑功能障碍。本文提出了一种通过马让迪孔，采用低角度手术入路切除第四脑室（59例）和脑干（18例）肿瘤的手术方法。根据肿瘤的位置，将其分为4个主要组：1）上部区域，8例；2）中部区域，14例；3）下部区域，20例；4）第四脑室下部区域肿瘤延伸至枕大池，12例；以及这些位置的各种组合，23例。所有手术均采用微创技术，软组织切口4cm，枕骨切除0 - 21mm（中位数12mm）。55例（71.4%；95%CI[60%，81%]）患者实现了肿瘤全切，其中第四脑室肿瘤患者48例（81.4%；95%CI[69%，90%]），脑干肿瘤患者7例（41.2%；95%CI[18%，64%]）（p <.001）。在第四脑室肿瘤中，肿瘤切除范围随肿瘤位置水平降低而减小（p = 0.05）。术后小脑功能障碍很少出现或明显恶化，第四脑室或脑干上部的肿瘤（p = 0.05）以及背腹径较小的肿瘤（p =.004）均如此。低角度经马让迪孔入路是治疗第四脑室和背侧脑干占位性病变的有效手术技术。
