Surgical approaches for brainstem tumors in pediatric patients

Cavalheiro, Sérgio; Yağmurlu, Kaan; Costa, Marcos Devanir Silva da; Nicácio, Jardel Mendonça; Rodrigues, Thiago; Chaddad-Neto, Feres; Rhoton, Albert L.

doi:10.1007/s00381-015-2799-y

Cited by 98 publications

(74 citation statements)

References 58 publications

(64 reference statements)

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“…This has become a real and transcendent paradigm change in the microsurgical approach to the brainstem. 1,[5][6][7] Safe entry zones are easily identifiable areas on the brainstem surface thanks to unambiguous anatomical references and are located where the underlying neurological structures are theoretically not clinically relevant to the patient and can be used as a corridor to reach lesions that are localized at a further depth. With this new vision, anterior, lateral, and posterior safe entries to the brainstem have been described.…”

Section: Discussionmentioning

confidence: 99%

“…With this new vision, anterior, lateral, and posterior safe entries to the brainstem have been described. 1,[5][6][7] However, Recalde et al 1 highlighted only three safe entry zones in the brainstem (one for each segment): the lateral mesencephalic sulcus, the peritrigeminal area, and the lower olivary nucleus. Therefore, for intrinsic cavernomas located in the ventral part of the pontomedullary brainstem, the safe entry areas are the peritrigeminal area in the pons and the olivary body in the medulla oblongata.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25][26][27] Other intrinsic pontomedullary lesions that benefit from radical surgical treatment are less frequent, such as intrinsic tumors that commonly occur in children and in which the same general surgical strategies are followed. 6 Fortunately, intrinsic brainstem tumors in adults are very rare, and metastases can be treated alternatively with radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

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Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions

González-Darder

Capilla-Guasch

Real-Peña

2019

J Neurol Surg B Skull Base

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Objectives The main objective of this article is to describe a simple and safe protocol for the microsurgical management of ventrally located intrinsic pontomedullary lesions based on the retrosigmoid approach, cortectomy performed utilizing safe entry zones of the pons and medulla, and a delicate microsurgical resection. The intraoperative protocol includes redundant procedures that provide security in decision-making during surgery. Design A prospective series of 11 cases is presented. All patients were studied following the same clinical and imaging workup. A regular retrosigmoid craniotomy surgical approach was utilized. The peritrigeminal area in the pons and the olivary area in the medulla were considered as the safe entry zones. Neuronavigation of the white fiber tracts and electrophysiological monitoring were used as intraoperative aids to locate the lesions, the safe entry zones, and the placement of the cortectomy. Results Six lesions were pontine, two medullary, and the remaining six pontomedullary. Eight lesions were cavernomas, while the remaining three tumors. Overall, we obtained a postoperative functional improvement in the affected cranial nerves in 90.1% of the patients and a total or partial recovery of long ascending or descending pathway symptoms in 72.3% of the patients. All the patients were satisfied with the procedure and the results. Conclusions Radical resection of ventral intrinsic pontomedullary lesions displays a high degree of intraoperative reliability, and a good clinical result is possible using simple surgical procedures. The anatomical references are the first element in the decision-making process during surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions

González-Darder

Capilla-Guasch

Real-Peña

2019

J Neurol Surg B Skull Base

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“…4,116 Some studies report tractography to be a valuable tool that has shaped the surgical strategy of intra-axial lesions profoundly. This includes approaches to the brainstem, 36,135,163,176,178,198,221,222,234 the insula, 58,179,182,291 the thalamus, 158,162,195,202 and the angular gyrus. 167…”

Section: Tractography In Neurosurgical Planningmentioning

confidence: 99%

Tractography in Neurosurgery: A Systematic Review of Current Applications

Wende

Hoffmann

Meixensberger

2020

J Neurol Surg A Cent Eur Neurosurg

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The ability to visualize the brain's fiber connections noninvasively in vivo is relatively young compared with other possibilities of functional magnetic resonance imaging. Although many studies showed tractography to be of promising value for neurosurgical care, the implications remain inconclusive. An overview of current applications is presented in this systematic review. A search was conducted for ((“tractography” or “fiber tracking” or “fibre tracking”) and “neurosurgery”) that produced 751 results. We identified 260 relevant articles and added 20 more from other sources. Most publications concerned surgical planning for resection of tumors (n = 193) and vascular lesions (n = 15). Preoperative use of transcranial magnetic stimulation was discussed in 22 of these articles. Tractography in skull base surgery presents a special challenge (n = 29). Fewer publications evaluated traumatic brain injury (TBI) (n = 25) and spontaneous intracranial bleeding (n = 22). Twenty-three articles focused on tractography in pediatric neurosurgery. Most authors found tractography to be a valuable addition in neurosurgical care. The accuracy of the technique has increased over time. There are articles suggesting that tractography improves patient outcome after tumor resection. However, no reliable biomarkers have yet been described. The better rehabilitation potential after TBI and spontaneous intracranial bleeding compared with brain tumors offers an insight into the process of neurorehabilitation. Tractography and diffusion measurements in some studies showed a correlation with patient outcome that might help uncover the neuroanatomical principles of rehabilitation itself. Alternative corticofugal and cortico-cortical networks have been implicated in motor recovery after ischemic stroke, suggesting more complex mechanisms in neurorehabilitation that go beyond current models. Hence tractography may potentially be able to predict clinical deficits and rehabilitation potential, as well as finding possible explanations for neurologic disorders in retrospect. However, large variations of the results indicate a lack of data to establish robust diagnostical concepts at this point. Therefore, in vivo tractography should still be interpreted with caution and by experienced surgeons.

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“…Unlike intrinsic infiltrative tumors of the neuroaxis (some of which may be resected when exophytic), noninfiltrative pathologies in the brainstem can frequently be resected with acceptable morbidity. 1,8,14,32 To optimize the resection of lesions while decreasing operative risk to the patient, the surgeon must select an approach that allows direct access to the lesion. Ideally, the approach uses the shortest distance, although this is not possible in every case, while minimally disturbing adjacent neural pathways.…”

mentioning

confidence: 99%