The tonsillouvular fissure approach: access to dorsal and lateral aspects of the fourth ventricle.

The tonsillouvular fissure approach: access to dorsal and lateral aspects of the fourth ventricle.

World Neurosurg. 2018 Mar 30;:

Authors: Aydin I, Hanalioglu S, Peker HO, Turan Y, Kina H, Cikla U, Baskaya MK

Abstract
OBJECTIVE: Although approaches to the fourth ventricle (FV) have been studied well, approaches to the lesions located in the dorsal and lateral aspects of the FV have not been demonstrated in anatomical or clinical studies. The aim of present study is to demonstrate the tonsillouvular fissure approach (TUFA) in anatomical dissections and its utilization in surgical series for the first time in the literature.
METHODS: For anatomical studies, four formalin-fixed human cadaveric heads infused with colored silicone and ten cerebellar specimens were dissected in a stepwise manner. Records of 12 patients operated via TUFA were also retrospectively reviewed.
RESULTS: Neurosurgical anatomy and critical steps of TUFA were described in detail. Among twelve patients with lesions around the FV (4 cavernous malformation, 2 pilocytic astrocytoma, 2 hemangioblastoma, 1 B-cell lymphoma, 1 metastatic papillary carcinoma, 1 dermoid cyst, and 1 arteriovenous malformation), eleven gross total and one subtotal resection were achieved via TUFA without any mortality or morbidity. Comparative analyses of four surgical approaches to FV (TUFA, telovelar/cerebellomedullary fissure, supratonsillar/tonsillobinventral lobule fissure and transvermian approaches) were also presented.
CONCLUSIONS: TUFA provides a direct route and excellent surgical view to lesions around FV, particularly on dorsal and lateral aspects, inferior vermis and medial part of dentate nucleus and cerebellar peduncles. It minimizes traversing the normal cerebellar tissue comparing to transvermian approach.

PMID: 29609087 [PubMed - as supplied by publisher]

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