Stereotactic Drainage of Brainstem Abscess With the BrainLab Varioguide™ System and the Airo™ Intraoperative CT Scanner: Technical Case Report

Abstract BACKGROUND AND IMPORTANCE Stereotactic biopsies or needle aspirations of posterior fossa lesions are technically challenging. Here we report a novel technique for performing these procedures employing the Airo™ intraoperative computed tomographic (CT) scanner and the VarioGuide™ articulated arm (BrainLab, Munich, Germany). CLINICAL PRESENTATION A 62-yr-old woman presented with an irregularly shaped, enhancing lesion of the left pons/middle cerebellar peduncle. Slowed diffusion on magnetic resonance imaging suggested an abscess, but no definitive infectious agent/source could be identified. When the patient deteriorated despite broad-spectrum antibiotic therapy, she was taken to the operating room for stereotactic drainage of the abscess employing the described technique. A specific infectious agent (Eikenella corrodens) was identified from the aspirate, allowing for tailored antibiotic therapy. The procedure was well tolerated and the patient made a full recovery with minimal neurological sequelae. CONCLUSION The combination of the Airo™ intraoperative CT and the Varioguide™ articulated arm allows for safe, accurate, and efficient targeting of posterior fossa lesions.

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Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Operative Neurosurgery ◽

10.1227/neu.0000000000000323 ◽

2014 ◽

Vol 10 (2) ◽

pp. 357-367 ◽

Cited By ~ 32

Author(s):

Ken Matsushima ◽

Toshio Matsushima ◽

Yoshihiro Kuga ◽

Yuji Kodama ◽

Kohei Inoue ◽

...

Keyword(s):

Posterior Fossa ◽

Lateral Surface ◽

Preoperative Assessment ◽

Anatomic Variations ◽

Drainage Pattern ◽

Middle Cerebellar Peduncle ◽

3 Dimensional ◽

Superior Petrosal Sinus ◽

Cerebellar Peduncle

Abstract BACKGROUND: The increasing number of reports of complications after sacrificing the superior petrosal veins, the largest veins in the posterior fossa, has led to a need for an increased understanding of the anatomy of these veins and the superior petrosal sinus into which they empty. OBJECTIVE: To examine the anatomy of the superior petrosal veins and their size, draining area, and tributaries, as well as the anatomic variations of the superior petrosal sinus. METHOD: Injected cadaveric cerebellopontine angles and 3-dimensional multifusion angiography images were examined. RESULTS: The 4 groups of the superior petrosal veins based on their tributaries, course, and draining areas are the petrosal, posterior mesencephalic, anterior pontomesencephalic, and tentorial groups. The largest group was the petrosal group. Its largest tributary, the vein of the cerebellopontine fissure, was usually identifiable in the suprafloccular cistern located above the flocculus on the lateral surface of the middle cerebellar peduncle. The medial or lateral segment of the superior petrosal sinus was absent in 40% of cerebellopontine angles studied with venography. CONCLUSION: The superior petrosal veins and their largest tributaries, especially the vein of the cerebellopontine fissure, should be preserved if possible. Obliteration of superior petrosal sinuses in which either the lateral or medial portion is absent may result in loss of the drainage pathway of the superior petrosal veins. Preoperative assessment of the superior petrosal sinus should be considered before transpetrosal surgery in which the superior petrosal sinus may be obliterated.

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Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

Child s Nervous System ◽

10.1007/s00381-020-05020-8 ◽

2021 ◽

Author(s):

Forrest A. Hamrick ◽

Michael Karsy ◽

Carol S. Bruggers ◽

Angelica R. Putnam ◽

Gary L. Hedlund ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patient ◽

Cerebellopontine Angle ◽

Resonance Imaging ◽

Middle Cerebellar Peduncle ◽

Cerebellar Tissue ◽

Cerebellar Peduncle ◽

Histopathologic Analysis ◽

The Right ◽

Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

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Progressive multifocal leukoencephalopathy with bilateral middle cerebellar peduncle lesions confirmed by repeated CSF-JC virus tests and coexistence of JC virus granule cell neuronopathy. Report of a case

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-000873 ◽

2016 ◽

Vol 56 (7) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

Daisuke Ito ◽

Keizo Yasui ◽

Yasuhiro Hasegawa ◽

Kazuo Nakamichi ◽

Masahisa Katsuno ◽

...

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Granule Cell ◽

Jc Virus ◽

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle ◽

Granule Cell Neuronopathy

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Isolated Bilateral Middle Cerebellar Peduncle Infarcts

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.03.035 ◽

2013 ◽

Vol 22 (8) ◽

pp. e645-e646 ◽

Cited By ~ 5

Author(s):

Seby John ◽

Mohamed Hegazy ◽

Esteban Cheng Ching ◽

Irene Katzan

Keyword(s):

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle

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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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Author response for "Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses"

10.1002/brb3.1778/v2/response1 ◽

2020 ◽

Author(s):

Jiwei Jiang ◽

Jirui Wang ◽

Meiqing Lin ◽

Xiaoting Wang ◽

Jinli Zhao ◽

...

Keyword(s):

Differential Diagnoses ◽

Author Response ◽

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle

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Decision letter for "Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses"

10.1002/brb3.1778/v2/decision1 ◽

2020 ◽

Keyword(s):

Differential Diagnoses ◽

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle

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Stereotactic Intratumoral Photodynamic Therapy for Recurrent Malignant Brain Tumors

Neurosurgery ◽

10.1227/00006123-199111000-00008 ◽

1991 ◽

Vol 29 (5) ◽

pp. 688-696 ◽

Cited By ~ 46

Author(s):

Stephen K. Powers ◽

Sharon S. Cush ◽

Diana L. Walstad ◽

Lester Kwock

Keyword(s):

Photodynamic Therapy ◽

Magnetic Resonance ◽

Malignant Gliomas ◽

Signs And Symptoms ◽

Resonance Spectroscopy ◽

Normal Brain ◽

Hematoporphyrin Derivative ◽

Neurological Sequelae ◽

Computed Tomographic ◽

Before And After

Abstract Photodynamic therapy (PDT) using purified hematoporphyrin derivative and stereotactic intratumorally implanted optical laser fiber(s) was used to treat patients with recurrent malignant gliomas and metastatic melanoma of the brain. Tumor response to PDT was evaluated by recording changes in the volume and pattern of tumor enhancement between computed tomographic and magnetic resonance imaging scans done before and after PDT, metabolic changes in tumor tissue by31 P magnetic resonance spectroscopy, and patient outcome. Toxicity of PDT to brain was evaluated on the basis of changes in the patients' neurological examinations and correlated with changes in brain adjacent to tumor seen on postoperative imaging studies. Dramatic tumor responses to PDT were seen in all gliomas, but no response of tumor to treatment was seen with melanoma. Transient signs and symptoms of increased peritumoral cerebral edema caused by PDT were seen in all patients. Two patients suffered permanent neurological sequelae, monocular blindness and a partial visual field defect, as a result of treatment. Two patients with recurrent anaplastic astrocytomas remain in remission at 45 and 35 weeks after PDT. We conclude that intratumoral photoradiation therapy of hematoporphyrin derivative-photosensitized malignant gliomas effectively produces necrosis of the solid component of malignant gliomas: however, intratumoral photoradiation may not reach the portion of tumor that invades normal brain.

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The cerebellar peduncle as localization of a recurrent atypical plexus papilloma: A case report

Surgical Neurology International ◽

10.25259/sni-189-2019 ◽

2019 ◽

Vol 10 ◽

pp. 65

Author(s):

Christian Saleh ◽

Stefanie Wilmes ◽

Kristine Ann Blackham ◽

Dominik Cordier ◽

Kerstin Hug ◽

...

Keyword(s):

Fourth Ventricle ◽

Tumor Recurrence ◽

Middle Cerebellar Peduncle ◽

Long Term Follow Up ◽

History Of ◽

Cerebellar Peduncle ◽

Left Middle ◽

Plexus Papilloma

Background: Choroid plexus papillomas (CPPs) are infrequently encountered brain tumors with the majority originating in the ventricular system. Rarely, CPP occurs outside of the ventricles. Case Description: We report the case of a recurrent CPP that initially originated within the fourth ventricle, though years later it recurred in the left middle cerebellar peduncle. Conclusion: Patients with cerebellar plexus papilloma need long-term follow-up comprising regular magnetic resonance imagings since, in patients with a history of CPP, any new mild symptomatology, even years after the initial presentation, may be an early sign of tumor recurrence.

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