Telo-velar approach to fourth-ventricle tumours: how I do it.

Background The telo-velar approach is an alternative to cerebellar splitting to gain access to the fourth ventricle through the so-called cerebello-medullary fissure (CMF). Method In this approach, the CMF is exposed and access to the ventricle is obtained by incising the tela chorioidea and inferior medullary velum. This approach enables the explora- tion of the entire ventricle cavity from the obex to the aqueduct. Conclusions The exposure of the fourth ventricle is satisfac- tory and the floor of the fourth ventricle can be visualised early and protected. The extent of resection and outcome are satis- factory in most patients, including those with large tumours or lesions attached to the lateral or superolateral recesses of the ventricle. The deep rostral tumour attachment is the main lim- itation of the telo-velar approach