Artikel
Telovelar approach neuro-navigation assisted to reach tumors located in the dorsal paramedian ponto-bulbar region
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Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Two relevant surgical routes to the fourth ventricle are the transvermian and the telovelar approaches. It is here reported our experience of two cases of dorsal paramedian ponto-bulbar lesions approached trough telovelar route assisted by neuronavigation.
Methods: Case 1: 27-year-old male, harbouring a cavernous hemangioma located paramedially and dorsally in the right ponto-bulbar region presenting with headache, vertigo and gait disorders.
Case 2: 69-year-old female harbouring a glioma of the right paramedian portion of the ponto-medullary region.
Clinical scenario was characterized by a progressively worsening right 6th, 7th and 9th nerves involvement.
In both patients the telovelar neuro-navigation assisted approach provided access through a “safe access zone”: the right infrafacial triangle to the paramedian region of the fourth ventricle floor. It was also possible to access the regions of the lateral and supero-lateral recesses, obex, striae medullaris, facial colliculus and calamus scriptorium.
Results: In case one a total lesion removal was obtained, while in case two a biopsy and subtotal resection of the lesion was feasible. In both cases no post-operative complications were appreciated. In case two a transitory postoperative worsening of the right 7th nerve paresis was appreciated.
Conclusions: Telovelar approach neuro- naviagation assisted offered an optimal surgical corridor through noneloquent arachnoid planes and a capacious working environment sparing splitting of the vermis.