Pushing the Limits of the Prone Position in the Intraoperative MR Suite

Winter, Fabian; Herta, Johannes; Niederle, Martin B.; Furtner, Julia; Rentenberger, Colleen; Hedrich, Cora; Roessler, Karl; Dorfer, Christian

doi:10.1227/ons.0000000000000404

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…In general, children were taken to the operating room (OR) at the earliest timepoint that allowed for the optimal operative environment usually within 2–3 days. Tumor resections were performed in a modified prone position (see Winter et al [ 9 ]). No sitting position has been used in the time period of this study.…”

Section: Methodsmentioning

confidence: 99%

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

et al. 2023

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Purpose The perioperative treatment of hydrocephalus in pediatric posterior fossa tumors with an external ventricular drain (EVD) is the treatment of choice in our center. We analyzed our experience in using EVD concerning safety and effectivity. Methods This is a single-center retrospective cohort study of 100 consecutive pediatric patients who underwent resection for a newly diagnosed tumor in the posterior fossa between 2011 and 2022. Results Of the 100 patients with posterior fossa tumors, 80 patients (80%) had radiological signs of hydrocephalus at presentation, 49 patients (49%) of whom underwent placement of an EVD. In 40 patients, the EVD was inserted at a mean of 2.25 days prior to the tumor resection; 9 had the EVD inserted during tumor resection (frontal trajectory in 7 patients, occipital trajectory in 2 patients). Histology revealed pilocytic astrocytoma in 48 patients, medulloblastoma in 32, ependymoma in 11, and other histologic entities in 9 patients. Gross total/near-total resection was achieved in 46 (95.83%) of the 48 pilocytic astrocytomas, 30 (93.75%) of the 32 medulloblastomas, and 11 (100%) of the 11 ependymomas. The mean number of total days with the EVD in place was 8.61 ± 3.82 (range 2–16 days). The mean number of days with an EVD after tumor resection was 6.35 ± 3.8 (range 0–16 days). EVD-associated complications were seen in 6 patients (12.24%) including one infection. None of these resulted in a worse clinical course or any long-term sequelae. Permanent CSF diversion at 6 months after surgery was necessary in 13 patients (13%), including two VP shunt, two SD-shunt, six endoscopic third ventriculostomy (ETV), and three combined VP shunt and ETV procedures. Patients with a medulloblastoma or ependymoma had a higher rate of permanent CSF diversion needed than the group of pilocytic astrocytoma patients (27.9% versus 2.13%, p < 0.001). In patients with metastatic disease, 7 of 17 patients (41.18%) needed a permanent CSF diversion, compared to 6 of 83 patients (7.23%) in the group without metastasis (p = 0.001). Conclusion The treatment of hydrocephalus in pediatric posterior fossa tumors with an EVD as a temporary measure is safe and effective, provided that a multi-professional understanding for its handling is given and there is no need for a long transport of the children.

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Section: Methodsmentioning

confidence: 99%

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

et al. 2023

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“…We refer to this as the telovelar-like approach. At our institution, the modified prone position for the telovelar and telovelar-like approach is the preferred method for the resection of fourth ventricular tumors [10].…”

Section: Study Population and Patient Characteristicsmentioning

confidence: 99%

The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary?

Cho,

Lippolis,

Herta

et al. 2024

Childs Nerv Syst

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Purpose Various surgical nuances of the telovelar approach have been suggested. The necessity of removing the posterior arch of C1 to accomplish optimal tumor exposure is still debated. Therefore, we report on our experience and technical details of the fourth ventricular tumor resection in a modified prone position without systematic removal of the posterior arch of C1. Methods A retrospective analysis of all pediatric patients, who underwent a fourth ventricular tumor resection in the modified prone position between 2012 and 2021, was performed. Results We identified 40 patients with a median age of 6 years and a M:F ratio of 25:15. A telovelar approach was performed in all cases. In 39/40 patients, the posterior arch of C1 was not removed. In the remaining patient, the reason for removing C1 was tumor extension below the level of C2 with ventral extension. Gross or near total resection could be achieved in 34/39 patients, and subtotal resection in 5/39 patients. In none of the patients, a limited exposure, sight of view, or range of motion caused by the posterior arch of C1 was encountered, necessitating an unplanned removal of the posterior arch of C1. Importantly, in none of the cases, the surgeon had the impression of a limited sight of view to the most rostral parts of the fourth ventricle, which necessitated a vermian incision. Conclusion A telovelar approach without the removal of the posterior arch of C1 allows for an optimal exposure of the fourth ventricle provided that critical nuances in patient positioning are considered.

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Current Aspects of Intraoperative High-Field (3T) Magnetic Resonance Imaging in Pediatric Neurosurgery: Experiences from a Recently Launched Unit at a Tertiary Referral Center

Roessler,

Winter,

Kiesel

et al. 2023

World Neurosurgery

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Pushing the Limits of the Prone Position in the Intraoperative MR Suite

Cited by 4 publications

References 16 publications

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary?

Current Aspects of Intraoperative High-Field (3T) Magnetic Resonance Imaging in Pediatric Neurosurgery: Experiences from a Recently Launched Unit at a Tertiary Referral Center

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