{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T23:53:30Z","timestamp":1768434810579,"version":"3.49.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2013,1,1]],"date-time":"2013-01-01T00:00:00Z","timestamp":1356998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2013,7,16]],"date-time":"2013-07-16T00:00:00Z","timestamp":1373932800000},"content-version":"vor","delay-in-days":196,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION:<\/jats:title>\n                    <jats:p>The authors explore a combined infratentorial-supracerebellar and telovelar approach in an adult, while avoiding vermian-splitting methods for a large, midline, fourth-ventricular tumor, unapproachable though a single traditional route. Experience with a combined surgical approach for pediatric patients has been published, but the authors believe that describing this combined method in an adult will provide a preliminary experience for further exploration of this approach in other adult patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PRESENTATION OF CASE:<\/jats:title>\n                    <jats:p>The authors present a review of the literature along with the case of a 60-year-old man with slight ataxia who presented with a 1-month history of gait difficulty and memory lapse. His MRI of the brain showed mild hydrocephalus and a large tumor of the fourth ventricle. Surgical removal through a suboccipital craniotomy was attempted, and part of the tumor overlying the tectum and the superior cerebellar velum was removed without difficulty. However, despite inferior retraction of the vermis, which allowed further resection of the tumor from the fourth ventricle, residual tumor in the caudal surgical resection cavity was present. Partial transection of the vermis was considered, but avoided because of potential neurological deficits. Instead, the authors redirected their approach and exposed the residual tumor by transecting the inferior medullary velum and removed additional tumor while avoiding the floor of the fourth ventricle. The infratentorial-supracerebellar and telovelar approach resulted in total gross resection of the tumor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION:<\/jats:title>\n                    <jats:p>For patients with large midline tumors that arise from the superior vermis or the quadrigeminal plate and fill the upper third of the fourth ventricular space, this combined approach may offer a unique possibility of safe tumor removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>This case demonstrates the benefit of a combined approach for a select group of patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2013.07.005","type":"journal-article","created":{"date-parts":[[2013,7,15]],"date-time":"2013-07-15T23:10:02Z","timestamp":1373929802000},"page":"842-845","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of single-staged resection of a fourth ventricular tumor via a combined infratentorial-supracerebellar and telovelar approach"],"prefix":"10.1097","volume":"4","author":[{"given":"Christoph J.","family":"Griessenauer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane R.","family":"Tubbs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-13-20260114","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00701-004-0407-0","article-title":"Telovelar approach to the fourth ventricle: operative findings and results in 16 cases","volume":"147","author":"El-Bahy","year":"2005","journal-title":"Acta Neurochirurgica"},{"key":"R3-13-20260114","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s00381-006-0295-0","article-title":"Telovelar approach: technical issues for large fourth ventricle tumors","volume":"23","author":"Rajesh","year":"2007","journal-title":"Childs Nervous System"},{"key":"R4-13-20260114","first-page":"ONS30","article-title":"Combined transventricular and supracerebellar infratentorial approach preserving the vermis in giant pediatric posterior fossa midline tumors","volume":"63","author":"Hermann","year":"2008","journal-title":"Neurosurgery"},{"key":"R5-13-20260114","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1159\/000055962","article-title":"A hazard of combining the infratentorial supracerebellar and the cerebellomedullary fissure approaches: cerebellar venous insufficiency","volume":"33","author":"Piatt","year":"2000","journal-title":"Pediatric Neurosurgery"},{"key":"R6-13-20260114","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s00701-003-0158-3","article-title":"One stage removal of periaqueductal glioma in adult via infratentorial supracerebellar and transaqueductal approaches","volume":"146","author":"Koziarski","year":"2004","journal-title":"Acta Neurochirurgica"},{"key":"R7-13-20260114","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S1042-3680(03)00061-5","article-title":"Surgical approaches to posterior third ventricular tumors","volume":"14","author":"Lozier","year":"2003","journal-title":"Neurosurgery Clinics of North America"},{"key":"R8-13-20260114","first-page":"436","article-title":"Surgical approaches to pathological lesions of the middle cerebellar peduncle and the lateral part of the pons - clinical observation","volume":"41","author":"Majchrzak","year":"2007","journal-title":"Neurologia i Neurochirurgia Polska"},{"key":"R9-13-20260114","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3171\/jns.2001.94.2.0257","article-title":"Transcerebellomedullary fissure approach with special reference to methods of dissecting the fissure","volume":"94","author":"Matsushima","year":"2001","journal-title":"Journal of Neurosurgery"},{"key":"R10-13-20260114","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1227\/00006123-198211000-00008","article-title":"Microsurgery of the fourth ventricle: Part 1. 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