The benefit and outcome prediction of acute surgery for hemorrhagic brainstem cavernous malformation with impending respiratory failure

Removal of brainstem cavernous malformation remains a surgical challenge. We present a case of a 63-year-old female who was diagnosed with a large cavernoma located in the medulla oblongata. The patient suffered three episodes of brainstem bleeding resulting in significant neurological deficits (hemiparesis, dysphagia, and dysarthria). It was decided to remove the cavernoma through a left-sided modified far lateral approach.3The operative video demonstrates the surgical steps and nuances of a complete removal of this complex medulla oblongata cavernous malformation. Total resection was achieved without complications. Postoperative MRI revealed no signs of residual cavernoma with clinical improvement.The video can be found here: https://youtu.be/BTtMvvLMOFM.

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Retrosigmoid transhorizontal fissure approach to lateral pontine cavernous malformation: comparison to transpetrosal presigmoid retrolabyrinthine approach

Journal of Neurosurgery ◽

10.3171/2020.12.jns203608 ◽

2021 ◽

pp. 1-10

Author(s):

Julia R. Schneider ◽

Amrit K. Chiluwal ◽

Mohsen Nouri ◽

Giyarpuram N. Prashant ◽

Amir R. Dehdashti

Keyword(s):

Operative Time ◽

Cavernous Malformation ◽

Similar Efficacy ◽

Middle Cerebellar Peduncle ◽

Entry Zone ◽

Cadaveric Dissection ◽

Cerebellar Peduncle ◽

Retrolabyrinthine Approach ◽

Brainstem Cavernous Malformation

OBJECTIVE The retrosigmoid (RS) approach is a classic route used to access deep-seated brainstem cavernous malformation (CM). The angle of access is limited, so alternatives such as the transpetrosal presigmoid retrolabyrinthine (TPPR) approach have been used to overcome this limitation. Here, the authors evaluated a modification to the RS approach, horizontal fissure dissection by using the RS transhorizontal (RSTH) approach. METHODS Relevant clinical parameters were evaluated in 9 patients who underwent resection of lateral pontine CM. Cadaveric dissection was performed to compare the TPPR approach and the RSTH approach. RESULTS Five patients underwent the TPPR approach, and 4 underwent the RSTH approach. Dissection of the horizontal fissure allowed for access to the infratrigeminal safe entry zone, with a direct trajectory to the middle cerebellar peduncle similar to that used in TPPR exposure. Operative time was longer in the TPPR group. All patients had a modified Rankin Scale score ≤ 2 at the last follow-up. Cadaveric dissection confirmed increased anteroposterior working angle and middle cerebellar peduncle exposure with the addition of horizontal fissure dissection. CONCLUSIONS The RSTH approach leads to a direct lateral path to lateral pontine CM, with similar efficacy and shorter operative time compared with more extensive skull base exposure. The RSTH approach could be considered a valid alternative for resection of selected pontine CM.

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Brainstem Cavernous Malformation Resection

10.18791/nsatlas.v3.ch04.4 ◽

2016 ◽

Author(s):

Aaron Cohen-Gadol

Keyword(s):

Cavernous Malformation ◽

Brainstem Cavernous Malformation

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Long-Term Outcome of Gamma Knife Radiosurgery for Symptomatic Brainstem Cavernous Malformation

World Neurosurgery ◽

10.1016/j.wneu.2018.05.164 ◽

2018 ◽

Vol 116 ◽

pp. e1054-e1059 ◽

Cited By ~ 2

Author(s):

Kawngwoo Park ◽

Jin Wook Kim ◽

Hyun-Tai Chung ◽

Sun Ha Paek ◽

Dong Gyu Kim

Keyword(s):

Gamma Knife ◽

Cavernous Malformation ◽

Gamma Knife Radiosurgery ◽

Term Outcome ◽

Long Term Outcome ◽

Brainstem Cavernous Malformation

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Postnatal delayed exacerbation of dural sinus malformation associated with brainstem cavernous malformations: A case report

Interventional Neuroradiology ◽

10.1177/1591019917720806 ◽

2017 ◽

Vol 23 (5) ◽

pp. 510-515 ◽

Cited By ~ 2

Author(s):

Katsuhiro Mizutani ◽

Tomoru Miwa ◽

Takenori Akiyama ◽

Tokunori Kanazawa ◽

Hideaki Nagashima ◽

...

Keyword(s):

Case Report ◽

Vascular Malformation ◽

De Novo ◽

Clinical Course ◽

Cavernous Malformation ◽

Venous Hypertension ◽

Dural Sinus ◽

Cavernous Malformations ◽

Dural Sinus Malformation ◽

Brainstem Cavernous Malformation

Dural sinus malformation (DSM) is a rare paediatric vascular malformation characterised by abnormal dilation of the posterior dural sinus. Owing to its rarity, the pathophysiology of DSM has not been fully elucidated. We report a case of prenatally diagnosed DSM with an unusual clinical course. We detected DSM in a male foetus in the 26th week of gestation by using foetal ultrasonography. Although the DSM regressed during the foetal stage and the arteriovenous shunt was insignificant in the neonate, the shunt rapidly developed four months after birth. The neonate also had postnatal de novo brainstem cavernous malformation (CM), which also developed rapidly, supposedly due to the aggravated venous hypertension resulting from the DSM. We successfully treated the aggravated shunts by endovascular transarterial and transvenous embolisation six times over two years and, subsequently, the clinical condition and the size of the brainstem CM became stable. The DSM and CM seemed to have a metameric origin. Such aberrant cases could help to further the understanding of DSM.

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