Thesis (Ph.D.) - Cairo University - Faculty of Medicine. - Department of Neurosurgery

Background and Objective; Fourth ventricle tumors have been traditionally approached by opening the cerebellar vermis. The 2telovelar3 approach is an alternative approach performed through the cerebellomedullary fissure to gain access to the fourth ventricle, avoiding neural tissue damage. We described our experience with this approach and predictive factors for the extent of resection (EOR) and for outcomes. Methods; We analyzed the data of pediatric patients who underwent resection of fourth ventricle tumors using a telovelar approach, between March 2015 and January 2017. We evaluated the extent of resection (EOR), clinical outcomes, complication rates, and postoperative cerebellar dysfunction. Univariate and multivariate analyses were performed to identify the predictive factors for EOR and outcomes including survival rate. Results; Forty-four patients were included in this series. Complete resection was obtained in 37 patients (84.1%). All patients (100%) had shunt dependency. 7 patients (15.9%) had CSF infection and one died 2 months after surgery. 6 patients (13.6%) had Cerebellar mutism (CM). 4 patients (9.1%) had new-onset lower cranial nerve palsy. 13 patients (30.2%) had disease progression, and 10 patients (23.3%) died during follow up. Conclusions; The telovelar approach offers potential advantages, with less complication rates than the transvermian approach, and should be the standard approach for lesions of the fourth ventricle

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