الفهرس 
Upper ventricular roof and cerebellomesencephalic fissureOnly 14 pages are availabe for public view
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Abstract
Our study was conducted between October 2014 and January 2018 on 20 pediatric patients with fourth ventricular tumors presented to Tanta University hospitals, Tanta, Egypt and Tohoku university hospital, Sendai, Japan meeting the inclusion criteria of the study. They had undergone surgery for excision of their lesions utilizing using telovelar approach via mid line suboccipital craniotomy (or craniectomy) to the fourth ventricle. The age of the patients ranged between (1 and 14 years with a mean of 6.300 ± 3.556 standard deviation SD), With slight male patients’ predominance with a male/female ratio of 3:2. The main presenting symptoms in the studied patients were headache, vomiting, abnormal gait, blurring of vision and double vision. papilledema and diplopia were the main signs. 17 patients (85 %) had obstructive hydrocephalus. VP shunts were inserted in 7 out of the 17 hydrocephalic patients (41.2%) from the start (before tumor excision), while in the other 10 hydrocephalic patients direct attack of the tumor was enough to resolve the problem of the associated hydrocephalus without any need for further CSF diversion procedure. Regarding the pathological types, medulloblastoma was the commonest histopathological tumor that was found in 15 cases of (75%), followed by ependymoma seen in 3 cases (15%), then choroid plexus carcinoma in one case (5%) and ganglioglioma in one case (5%). Telovelar approach provided an excellent tumor exposure and adequate panoramic visualization of the entire fourth ventricle without splitting of the vermis. Safe tumor excision could be performed with minimal cerebellar retraction, less tissue trauma, clear visualization of lateral recesses, and hence, less morbidity and better patient outcome. Gross total tumor resection could be safely achieved in almost all our patients (95%). The only post-operative complications encountered in the studied patients were transient cerebellar mutism and oropharyngeal apraxia (one case) that were managed conservatively.