Abstract:
OBJECTIVE:To compare the effectiveness of the telovelar approach with tonsillar manipulation for approaching the recesses of the fourth ventricle. METHODS:A telovelar approach was performed in 8 injected cadaveric heads. Areas of exposure were measured for the superolateral and lateral recesses. Horizontal angles were evaluated by targeting the cerebral aqueduct and medial margin of the lateral recess. Quantitative comparisons were made between the telovelar dissections and various tonsillar manipulations. RESULTS:Tonsillar retraction provided a comparable exposure of the superolateral recess with tonsillar resection (26.4 +/- 17.6 vs 25.2 +/- 12.5 mm2, respectively; P = .825). Tonsillar resection significantly increased exposure of the lateral recess compared with tonsillar retraction (31.1 +/- 13.3 vs 20.2 +/- 11.5 mm2, respectively; P = .002). Compared with tonsillar retraction, the horizontal angle to the lateral recess increased after either contralateral tonsillar retraction (22.7 +/- 4.8 vs 36.7 +/- 6.5 degrees) or tonsillar resection (22.7 +/- 4.8 vs 31.5 +/- 7.6 degrees; all adjusted P < .01). The horizontal angle to the cerebral aqueduct increased significantly with tonsillar resection compared with tonsillar retraction (17.6 +/- 2.3 vs 13.2 +/- 2.8 degrees; P < .001) CONCLUSION:Compared with tonsillar retraction, tonsillar resection provides a wider corridor to, and a larger area of exposure of, the cerebral aqueduct and lateral recess. Contralateral tonsillar retraction improves access to the lateral recess by widening the surgical view from the contralateral side.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Jittapiromsak P,Sabuncuoglu H,Deshmukh P,Spetzler RF,Preul MCdoi
10.1227/01.NEU.0000348558.35921.4Esubject
Has Abstractpub_date
2010-03-01 00:00:00pages
30-9; discussion 39-40issue
3 Suppl Operativeeissn
0148-396Xissn
1524-4040pii
00006123-201003002-00005journal_volume
66pub_type
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