الفهرس 
Fourth ventricleOnly 14 pages are availabe for public view
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Abstract
Objective:
to compare the results of telovelar and transvermian approaches in the management of fourth ventricular tumors regarding to clinical outcome and extent of tumor excision. Also to correlate the results of each approach with age of patients, tumor location, size and pathological nature to evaluate the impact of these factors on each approach.
Methods:
This study includes forty patients presented at Ain Shams University Hospital and Nasser Institute with the diagnosis of fourth ventriclar tumors in 4 years period between 2010 to 2014. The age of the patients range from 5 years to 50 years old of both sexes with four different pathological nature (ependymoma, medulloblastoma, astrocytoma and choroid plexus papilloma), twenty patients of them underwent telovelar approach and twenty patients underwent transvermian approach.
Results:
In total forty patients in our study total surgical excision was achieved in 27 patients (67.5% of all patients),fifteen patients of them operated via telovelar approach (75% of patients operated via telovelar approach).Twelve patients via transvermian approach(60% of patients operated via transvermian approach), Subtotal removal of the tumor was accomplished in 13 patients (32.5% of all patients), five patients of them operated via telovelar approach out (25% of patients operated via telovelar approach), eight patients via transvermian approach(40% of patients operated via transvermian approach). Regarding to prognosis the patients Classified into three group:The first group contains patients with improvement of Karnofsky Performance Status scale, twenty patients (50% of all patients), Ten patients of them operated via telovelar approach, ten patients operated via transvermian approach. The second group contains patients with the same Karnofsky Performance Status scale, ten patients (25% of all patients) Six patients of them operated via telovelar approach, Four patients operated via transvermian approach. The third group contains patients with deterioration of Karnofsky Performance Status scale, ten patients (25% of all patients).Four patients of them operated via telovelar approach, Six patients operated via transvermian approach.
Conclusion:
Telovelar approach can give better exposure to the fourth ventricle in cranio-caudal direction and lateral direction without splitting of the vermis or injury to vital neural structures so can be used in lesions in the lower half of the fourth ventricle, lesions occupy the whole ventricle and lesions extend into foramina of luschka and magendi, while in lesions in the upper half we can begin with telovelar but if it is impossible to excise the tumor totally we have to turn into transvermian approach.