Treatment of fourth ventricular tumors

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Fourth ventricular tumors pose a surgical challenge, albeit less than their third ventricular counterparts, because of their relation to the brainstem; this relation can vary from simply displacement to invasion.

This technical challenge is further complicated because the tumor is often concealed by key cerebellar structures, including the cerebellar tonsils and hemispheres or the vermis. Tumors may involve adjacent structures through extension via the foramen of Luschka and by reaching the premedullary, cerebellomedullary, prepontine, and anterior spinal cisterns.

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Anatomy
Tumors of the fourth ventricle commonly originate from the following structures composing the floor: the ependyma, choroid plexus, and tela choroidea. Lesions may also arise outside the ventricle and secondarily extend into this chamber, including medullary, tectal, and cerebellar hemispheric masses. These lesions are thus accessible via a fourth ventricular approach.

Importantly, preoperative magnetic resonance imaging (MRI) may be inconclusive with regard to the presence of brainstem invasion, and in fact, it can often be falsely indicative of invasion. Many fourth ventricular tumors, particularly those with an exophytic growth pattern, have a vascularized pedicle and demonstrate compression of the adjacent structures, but lack invasion.

Lateral extension into the fourth ventricle’s outlets typically occurs in medulloblastomas, ependymomas, and gliomas. This extension may progress to involve the foramen of Luschka and even cerebellopontine angle cisterns. This tumor configuration can facilitate cranial nerve involvement via tumor impingement or encasement. Similarly, caudal extension may progress via the obex to affect the superior cervical spinal cord and produce upper cervical myelopathy or even radiculopathy.
Diagnosis and Evaluation
Hydrocephalus and gait ataxia are common symptoms and signs. Dysmetria and dysdiadochokinesia are possible with laterally located tumors. Less common signs include diplopia, facial weakness, and lower cranial nerve dysfunction. Commonly encountered in the fourth ventricle are ependymomas, medulloblastomas, epidermoid cysts, pilocytic astrocytomas, hemangioblastomas, and cavernous malformations.
Treatment
MICROSURGICAL RESECTION OF FOURTH VENTRICULAR TUMORS
Historically, the approach to fourth ventricular tumors involved either cerebellar hemisphere resection or vermian split. Vermian split syndrome is characterized by neurobehavioral abnormalities, imbalance, and cerebellar mutism. In an attempt to avoid these untoward side effects, an alternative approach has been designed.

The telovelar (transcerebellomedullary fissure) approach is flexible and allows resection of most lesions in this area. It facilitates generous exposure of most of the fourth ventricular space, with minimal disruption of the normal structures.
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More information about the diagnosis can be found at the link TUMORS OF THE FOURTH VENTRICLE
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When applying to our clinic, it is desirable to have:

MRI scans, doctor's opinion, tests

TEAM
VOLODYMYR FEDIRKO
Doctor of Medical Sciences, head of department
Work experience: 32 years
PETRO ONISHCHENKO
Candidate of medical sciences, Doctor-neurosurgeon
Work experience: 34 years
OLEXANDR LISYANYI
Doctor of Medical Sciences, Doctor-neurosurgeon
Work experience: 26 years
ANDRIY NABOYCHENKO
Doctor-neurosurgeon

Work experience: 12 years

TESTIMONIALS

Sholina Ksenia
4 years have passed, and our whole family remembers with the same trepidation the miracle that the dear Vladimir Olegovich did for us. When everyone refused, he took and saved my life ...
Bilda Valentyn
I would like to thank my savior, Fedirko Vladimir Olegovich and the entire team for the removal of subtentorial neurooncology. Separately, I thank my guardian angel, Oksana, who did not leave me, day and night.
Kutovaya Elena
Low bow to all the medical staff, especially Vladimir Olegovich Fedirko. In 2012, my mother was operated on with a diagnosis of trigeminal neuralgia. We arrived in Kiev without even a referral and Vladimir Olegovich heard us and appointed the day of the operation.
Maltseva Victoria
Our family is truly grateful to Vladimirovich Olegovich and the entire team of the clinic for their professional work. Behind this familiar "thank you" is actually an ocean of our and my mother's hopes, worries, fears, sleepless nights ... We have never regretted our decision. Thank you.
Andriychuk Viktoria
Thanks for the golden hands and invaluable knowledge to Vladimir Olegovich Fedirko, as well as to the entire team of the clinic! After a successfully and professionally performed surgery in 2014, this year I became a mother!
ABOUT US
Institute of Neurosurgery
The Clinic of Subtentorial Neurooncology of the Institute of Neurosurgery was founded in 1988 as a subdivision of the Department of Neurooncology of the Institute of Neurosurgery named after A.P. Romodanova
Best Neurosurgeons
Every year the clinic staff performs more than 500 complex operations at a modern, highly professional level
Complex Operations
Treatment of neurosurgical diseases of the posterior fossa, brainstem, craniobasal localization, cranial nerves and other complex localizations
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WHAT DO WE OFFER?
Consultation
We are always ready to study in detail your case in the initial examination mode in inoperable hours.
Operation
Do you already know that your case is operable? Then we are waiting for you in our office at the initial inspection.
Accompaniment
After treatment, our patients remain under supervision for life.
When applying to our clinic, it is desirable to have:

MRI scans, doctor's opinion, tests

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