Microsurgical Resection of Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video

Abstract This video demonstrates the microsurgical resection of brainstem hemangioblastoma. The patient is a 32-yr-old woman with Von Hippel Lindau syndrome who presented with quadriparesis and inability to swallow. Magnetic resonance imaging (MRI) of the neuroaxis revealed a brainstem cystic lesion with contrast-enhancing tumor nodule right along the posterior aspect of the lower part of medulla oblongata. The surgery was performed in the prone position with suboccipital craniectomy and partial C1 posterior arch removal. The aim of the surgery was to remove the tumor nodule.1-12 The tumor was separated from the right dorsal nerve roots, and then progressively dissected with coagulation of arterial feeders and draining vein and division of the pia circumferentially. Postoperative MRI revealed complete resection. The patient completely recovered from her quadriparesis and difficulty swallowing.

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Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211117142203 ◽

2021 ◽

Vol 17 ◽

Author(s):

Renjie Wang ◽

Yankun Shao ◽

Lei Xu

Keyword(s):

Medulla Oblongata ◽

Clinical Manifestations ◽

Lateral Medullary Infarction ◽

Case Presentation ◽

Specific Sign ◽

Temperature Sense ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

The Brain ◽

Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

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Microsurgical resection of a large cavernous malformation of the medulla oblongata

Neurosurgical Focus: Video ◽

10.3171/2019.7.focusvid.1998 ◽

2019 ◽

Vol 1 (1) ◽

pp. V25

Author(s):

Sima Sayyahmelli ◽

Mustafa K. Başkaya

Keyword(s):

Surgical Resection ◽

Medulla Oblongata ◽

Cavernous Malformation ◽

Foramen Magnum ◽

Total Resection ◽

Postoperative Course ◽

Suboccipital Craniotomy ◽

Postoperative Mri ◽

Microsurgical Resection

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

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Complete Microsurgical Resection of Large Retrochiasmatic Hypothalamic Craniopharyngioma by Transpetrosal Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz250 ◽

2019 ◽

Author(s):

Qazi Zeeshan ◽

Juan P Carrasco Hernandez ◽

Nina T Yoh ◽

Laligam N Sekhar

Keyword(s):

Frozen Section ◽

Brain Magnetic Resonance Imaging ◽

Optic Chiasm ◽

Pituitary Stalk ◽

Excessive Sleepiness ◽

Microsurgical Resection ◽

Magnetic Resonance Imaging Mri ◽

Prefixed Chiasm ◽

The Right ◽

Retrochiasmatic Region

Abstract This two-dimensional video shows the technical nuances of complete microsurgical resection of a hypothalamic craniopharyngioma located in the retrochiasmatic region by the transpetrosal approach. This 49-yr-old man presented with progressive fatigue, excessive sleepiness, and difficulty in vision in both eyes. He was found to have right CN 3 paralysis and bitemporal hemianopsia on neurological examination. Further workup revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) demonstrated a large solid retrochiasmatic hypothalamic lesion with homogeneous contrast enhancement, measuring 2.1 × 2.6 × 2.4 cm. Optic chiasm was prefixed, and the tumor was just posterior to the pituitary stalk area. The preoperative differential diagnosis included hypothalamic astrocytoma, craniopharyngioma, germinoma, and histiocytosis. Because of the prefixed chiasm, a presigmoid, transpetrosal approach was performed. Our initial plan was a large biopsy, but based on frozen section histology, we decided to excise the tumor completely. The tumor had a pseudocapsule, which was firm and yellowish. It was debulked, dissected from the surrounding hypothalamus, and removed completely. The pituitary stalk was found at the anterior and inferior ends of the tumor and was preserved. Postoperatively, the patient developed diabetes insipidus and requires desmopressin replacement, which was gradually tapered. For panhypopituitarism, he is receiving thyroxine, hydrocortisone, and testosterone. Postoperatively, patient had an improvement in vision in his left eye and ptosis was improving in the right eye with mRs 1- at 10-wk follow-up. An informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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Atlanto-axial subluxation with cervical myelopathy operated with occipital C2 fusion: A case report

Journal of Medical Research and Innovation ◽

10.15419/jmri.3 ◽

2017 ◽

Vol 1 (1) ◽

pp. 4-7

Author(s):

Rahul Kadam ◽

Vishal Bauva ◽

Krutarth Shah ◽

Sunil Yadav

Keyword(s):

Case Report ◽

Cervical Myelopathy ◽

Muscle Tone ◽

Rare Condition ◽

Posterior Arch ◽

Atlantoaxial Joint ◽

Posterior Aspect ◽

Posterior Displacement ◽

Grisel Syndrome ◽

Magnetic Resonance Imaging Mri

Background: Atlantoaxial subluxation with cervical myelopathy is a rare condition that can occur mainly by trauma followed by Rheumatoid arthritis, Grisel syndrome, Down’s syndrome and various other metabolic disorders. It is characterized by excessive movement of atlas (C1) over axis (C2) either by bony or ligamentous abnormality. Due to its laxity the spinal cord may get damaged and cause neurologic symptoms. Reduction and fixation is needed for such instability. Case Report: This 55-year-old gentleman was apparently all right 4 years back when he gradually developed difficulty in walking and imbalance. Bilateral Babinski sign was positive, All deep tendon reflexes were brisk; muscle tone was increased with clasp-knife spasticity present in all four limbs. Ankle and patellar clonus was present bilaterally. His X-ray cervical spine showed C1-C2 subluxation in flexion and extension views. Magnetic resonance imaging (MRI) of Cranio-vertebral junction. Mild subluxation of atlantoaxial joint (3.1 mm) with posterior displacement of dens causing narrowing of bony cervical spinal canal with reduced distance between posterior aspect of dens of C2 and anterior aspect of posterior arch of C1 vertebrae was noticed. Atlas was also slightly displaced anteriorly in relation to baso-occiput. We managed this patient with occipital cervical fusion after reduction from a posterior approach using screws and rods construct and fusion with bone graft from iliac crest. Post operatively the patient was able to walk without any support and tone of the muscles in lower limb decreased, no tingling or numbness are present, no signs of local infection or inflammation. Conclusion: We suggest to operate atlanto-axial subluxation and cervical myelopathy with occipital C2 fusion.

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Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab198 ◽

2021 ◽

Author(s):

Matías Baldoncini ◽

Alvaro Campero ◽

Sabino Luzzi ◽

Juan F Villalonga

Keyword(s):

Right Hemisphere ◽

Vascular Lesion ◽

Neurological Deficits ◽

3 Dimensional ◽

Postoperative Mri ◽

Drainage Vein ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Superior Longitudinal Sinus ◽

The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4 The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5 This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes. The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece. The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM. In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

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Retrosigmoid Approach for Resection of Cerebellar Peduncle Cavernoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669974 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S420-S421

Author(s):

Hussam Abou-Al-Shaar ◽

Gmaan Alzhrani ◽

Yair Gozal ◽

William Couldwell

Keyword(s):

Acute Onset ◽

Middle Cerebellar Peduncle ◽

Postoperative Mri ◽

History Of ◽

Horizontal Gaze ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri ◽

Residual Blood ◽

The Right

The case described in this video involved a 38-year-old man, who presented with a 4-week history of worsening acute-onset headache, nausea, double vision, and vertigo. On examination, he had impaired tandem gait and diplopia on right horizontal gaze. A computed tomography (CT) scan revealed a hyperdense lesion of the right cerebellopontine angle. Magnetic resonance imaging (MRI) revealed a nonenhancing middle cerebellar peduncle lesion that was isointense on T2-weighed imaging and hypointense on FLAIR imaging (Fig. 1A–B). The differential diagnoses for this lesion included cavernous malformation, thrombosed aneurysm, and neurocysticercosis. CT angiography was done preoperatively to rule out cerebral aneurysm. Surgical resection of the lesion was recommended to relieve his symptoms, to prevent further deterioration/bleeding, and to obtain a pathological diagnosis. The patient underwent a right retrosigmoid craniotomy for resection of the right middle cerebellar peduncle cavernoma (Fig. 2). The patient tolerated the procedure well with no new postoperative neurological deficit. Postoperative MRI depicted gross total resection of the lesion and expected residual blood in the resection cavity (Fig. 1C–D). The patient was discharged home on postoperative day 4. At his last follow-up appointment, 1 month after surgery, he reported complete resolution of his preoperative symptoms, including diplopia. The patient gave consent for publication.The link to the video can be found at: https://youtu.be/TRieS9DXbV4.

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Pontine Atypical Neurocytoma: Case Report

Neurosurgery ◽

10.1227/01.neu.0000210213.12847.1e ◽

2006 ◽

Vol 58 (5) ◽

pp. E990-E990 ◽

Cited By ~ 23

Author(s):

Bradley M. Swinson ◽

William A. Friedman ◽

Anthony T. Yachnis

Keyword(s):

Clinical Presentation ◽

Cystic Mass ◽

External Beam Radiation ◽

Subtotal Resection ◽

Beam Radiation ◽

Suboccipital Craniectomy ◽

Mri Scans ◽

Atypical Neurocytoma ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE: Neurocytomas are typically located within the supratentorial ventricular system. Extraventricular neurocytomas are very rare, and this is only the second reported case of a pontine neurocytoma. We discuss the clinical presentation, histology, and treatment of these rare tumors. CLINICAL PRESENTATION: A 58-year-old man presented with a 4-month history of headache and unilateral facial and distal extremity paresthesia. Magnetic resonance imaging (MRI) scans demonstrated a 2.6 × 2.2-cm ring-enhancing cystic mass in the right pons. INTERVENTION: MRI-guided stereotactic biopsy yielded a diagnosis of atypical neurocytoma. Because of the location and malignant histological features of the tumor, the patient was initially treated with external beam radiation therapy. Several months later, MRI scans demonstrated tumor progression. The patient then underwent three rounds of temozolomide chemotherapy, during and after which his symptoms worsened. Aggressive subtotal resection of the tumor was achieved via a right suboccipital craniectomy. CONCLUSION: Twenty-eight months postoperatively, the patient is symptom free, and MRI scans demonstrate no evidence of residual or recurrent tumor.

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Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy082 ◽

2018 ◽

Vol 16 (1) ◽

pp. E8-E8 ◽

Cited By ~ 2

Author(s):

Abdulrahman Alturki ◽

Alejandro Enriquez-Marulanda ◽

Raghav Gupta ◽

Ajith J Thomas ◽

Christopher S Ogilvy

Keyword(s):

Cranial Nerve ◽

Complete Resection ◽

Resonance Imaging ◽

Dorello’S Canal ◽

Suboccipital Craniectomy ◽

Operative Case ◽

Patient Consent ◽

History Of ◽

Microsurgical Resection ◽

The Right

Abstract We describe the case of a 73-yr-old female patient with a 2-yr history of diplopia that has progressively become worse. Physical examination revealed a right VI cranial nerve (CN) palsy. Magnetic resonance imaging and angiography showed a dolichoectatic basilar artery near the VI CN. A suboccipital craniectomy was performed, initially with the intention to perform a microvascular decompression; however, a red mass was encountered at the entrance of the right Dorello's canal that was compressing the VI CN. Complete resection of the lesion was done and decompression of the nerve was accomplished. In the following video illustration, we narrate this operative case and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

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Microsurgical Resection of Brain Stem Ependymoma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz252 ◽

2019 ◽

Vol 18 (6) ◽

pp. E240-E241 ◽

Cited By ~ 1

Author(s):

Mirza Pojskić ◽

Vincent Nguyen ◽

Goran Lakičević ◽

Kenan I Arnautović

Keyword(s):

Spinal Cord ◽

Medulla Oblongata ◽

World Health ◽

Intramedullary Tumor ◽

Posterior Arch ◽

Total Resection ◽

Brainstem Lesion ◽

Common Location ◽

Grade Ii ◽

Microsurgical Resection

Abstract The brainstem is a less-common location for ependymomas than the spinal cord where they are the most common adult intramedullary tumor.1-18 In this first video case report in the peer-reviewed literature, we demonstrate microsurgical resection of a medulla oblongata ependymoma. There are several case reports of medulla oblongata ependymomas1,3,5,6,13 and a few series of spinal cord ependymomas that included cases of ependymomas of the cervicomedullary junction.9,10 The goal of surgery was to stabilize the preoperative neurological function; favorable outcome is achieved in patients with good preoperative statuses and well-defined tumor boundaries.9 Although gross total resection (GTR) provides the best overall outcome, it is most effective for classic grade II tumors, but not grade I (myxopapillary) and ependymomas, which have a lower GTR rate.14,15 A 55-yr-old patient developed 4-extremity weakness and dysphagia. Pre-/postcontrast magnetic resonance imaging (MRI) revealed centrally located brainstem lesion situated at the lower half of the medulla oblongata. Surgery, performed by the senior author, was performed in the prone position with a small suboccipital craniectomy and C1 posterior arch removal, followed by pia opening and posterior midline myelotomy. Tumor was debulked, dissected from the white matter, and resected. Histology revealed ependymoma (World Health Organization grade II). Postoperative pre-/postcontrast MRI revealed total resection. The patient's neurological deficit completely resolved postoperatively. Written consent was obtained from the patient.

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Microsurgical Resection of Vestibular Schwannomas, Presentation of Cases in 3D: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz271 ◽

2019 ◽

Vol 19 (1) ◽

pp. E61-E62

Author(s):

Alvaro Campero ◽

Matias Baldoncini

Keyword(s):

Facial Nerve ◽

Cochlear Nerve ◽

Vestibular Schwannomas ◽

Benign Tumors ◽

3 Dimensional ◽

Microsurgical Resection ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Functional Preservation

Abstract Vestibular schwannomas are the most common benign tumors of the pontocerebellar angle,1,2 their microsurgical complexity is related to their size and neurovascular relationships. The purpose of this work is to analyze the clinical, anatomic characteristics, microsurgical treatment, and the postoperative results according to the Hannover gradual scale in 4 patients with vestibular schwannomas. The 4 patients gave their consent to the procedure and all consented to the use of their surgical videos, preoperative and postoperative studies, and postoperative pictures. Case 1: A 39-yr-old woman, with left ear hearing loss. Magnetic resonance imaging (MRI) showed small Intracanalicular schwannoma (T1 classification by Hannover). Microsurgery was performed and resection through a retrosigmoid approach2,3 with anatomic and functional preservation of the facial and cochlear nerve. Case 2: A 40-yr-old woman, with left ear hypoacusia. MRI showed an extrameatal schwannoma reaching the brainstem (T3b Hannover classification). The complete re-section through retrosigmoid approach were performed. Case 3: A 69-yr-old woman, without hearing in the right ear. RM: Medium schwannoma (T4a classification of Hannover). Microsurgery was performed with anatomic and functional preservation of the facial nerve.4-6 Case 4: A 32-yr-old woman, without hearing in the left ear. In addition, cerebellar syndrome and headache. RM: Large schwannoma (T4b classification of Hannover). Sur-gery was performed, anatomic preservation of the facial nerve, with moderate paresis in the postoperative period. Microsurgical resection with functional preservation of the facial and cochlear nerve is the main objective7 when addressing this pathology.

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