Telovelar Approach to Pediatric Fourth Ventricle Tumors: Feasibility and Outcome

Abstract

AIM: To describe our institution’s experience with the telovelar approach as well as factors governing radicality and outcome forpediatric fourth ventricle tumors.MATERIAL and METHODS: During March 2015–January 2017, 44 children with fourth ventricular tumors were operated using thetelovelar approach. Radicality, neurological outcome, complications, and survival rates were evaluated. Statistical analysis wasperformed to determine factors associated with radicality and neurological outcome.RESULTS: Gross tumor removal was achieved in 37 patients (84.1%). All patients required cerebrospinal fluid (CSF) diversionthrough a ventriculoperitoneal shunt. Six patients (13.6%) developed cerebellar mutism, 4 patients (9.1%) developed bulbarparalysis (lower cranial nerve palsy), and 13 patients (30.2%) had tumor recurrence. Medulloblastoma was associated with thehighest risk of cerebellar mutism (p=0.040). A poor prognosis (according to overall and progression-free survival rates) wasassociated with subtotal resection (p=0.020), large cell/anaplastic medulloblastoma and anaplastic ependymoma (p=0.038), highrisk medulloblastoma (p=0.005), and CSF seeding (p