Wide opening of the uvulo-tonsillar space to facilitate early intraoperative control of feeding arteries in fourth ventricular tumor surgery: How I do it.

Abstract

The feeding arteries of fourth ventricular tumors often arise from the posterior inferior cerebellar artery (PICA), particularly the tonsillomedullary and telovelotonsillar segments. Achieving early control of these feeders is critical to minimize bleeding. We present a surgical technique that facilitates early control of feeders from the telovelotonsillar segment, which courses dorsally to the inferior medullary velum and tela choroidea, by wide and deep opening of the uvulo-tonsillar space before tumor manipulation. This technique enables early interruption of PICA feeders, allowing safe and effective devascularization of fourth ventricular tumors with abundant arterial supply.