scholarly journals Giant Cervical Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E153-E153
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Video Recording ◽  
Gross Total Resection ◽  
Cervical Cord ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Institutional Review ◽  
High Cervical

Abstract Cervical spinal cord cavernous malformations are rare but can be neurologically devastating lesions and, when symptomatic, are best treated with gross total resection to prevent progressive neurologic decline related to recurrent hemorrhage. This patient had a large high cervical cord cavernous malformation with evidence of recent hemorrhage. A midline myelotomy was utilized to enter the cavernous malformation. The cavernous malformation was then circumferentially separated from the spinal parenchyma and removed in a piecemeal manner. Postoperative imaging confirmed gross total resection of the lesion with preservation of the surrounding spinal cord. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Endoscopic Resection of Hemorrhaged Third Ventricle Cavernous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E51-E51
Author(s):  
Giorgio Palandri ◽  
Thomas Sorenson ◽  
Mino Zucchelli ◽  
Nicola Acciarri ◽  
Paolo Mantovani ◽  
...  
Keyword(s):  
Gold Standard ◽  
Intraventricular Hemorrhage ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Gross Total Resection ◽  
Vascular Lesions ◽  
Total Resection ◽  
Cavernous Malformations ◽  
The Third

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.

scholarly journals Left Retrosigmoid Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E2-E2
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Preoperative Planning ◽  
Cavernous Malformation ◽  
Video Recording ◽  
Close Inspection ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field ◽  
Cerebellar Peduncle

Abstract Pontine cavernous malformations are highly morbid lesions that require thorough preoperative planning of the surgical approach and meticulous surgical technique to successfully remove. The patient in this case has a large pontine cavernous malformation coming to the parenchymal surface along the pontine–middle cerebellar peduncle interface. The depth of the surgical field and narrow trajectory of approach require use of lighted suction, lighted bipolar forceps, and stereotactic neuronavigation to successfully locate and remove the entire lesion. The cavernous malformation is removed in a piecemeal manner with close inspection of the resection cavity for any remnants. Postoperative imaging demonstrates gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Resection of a Pontine Cavernous Malformation via an Endoscopic Endonasal Approach

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE186-onsE194 ◽  
Author(s):  
Matthew M. Kimball ◽  
Stephen B. Lewis ◽  
John W. Werning ◽  
J D. Mocco
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Conservative Management ◽  
Cavernous Malformation ◽  
Gross Total Resection ◽  
Total Resection ◽  
Transnasal Approach ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation CLINICAL PRESENTATION: A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection. CONCLUSION: The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.

scholarly journals Supracerebellar Transtentorial Approach for Mesial Temporal Lobe Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E236-E236 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Stereotactic Navigation ◽  
Mesial Temporal Lobe ◽  
Transtentorial Approach

Abstract Medial temporal cavernous malformations can involve transgression of eloquent parenchyma. For a tentorium-abutting temporal cavernous malformation, the supracerebellar transtentorial corridor is a suitable approach with minimal parenchymal insult. Using dynamic and gravity retraction, lighted bipolar forceps and suction, and stereotactic navigation, this trajectory provides a minimally invasive corridor. The patient in this case has a medial temporal cavernous malformation, with the lesion abutting the tentorial leaflet. The cavernous malformation is accessed and removed in a piecemeal manner. Complete removal of the lesion is achieved. The patient remained neurologically stable after the procedure. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Midline Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E239-E239
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Choroid Plexus ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Institutional Review Board ◽  
Total Resection ◽  
Operating Room Table ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Intraoperative Visualization

Abstract This patient presented with a cavernous malformation in the inferior posterior third ventricle extending into the aqueduct. The patient was positioned supine on the operating room table with the head rotated into the horizontal plane. The choroidal fissure is opened lateral to the choroid plexus. This technique allows for the choroid plexus to serve as protection against forniceal manipulation. Rigid retraction was applied to the cerebral falx and corpus callosum to permit aqueductal visualization. The lighted instruments are paramount for adequate visualization of the third ventricle and during dissection of the lesion. Intraoperative visualization and postoperative imaging confirm gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute.

Intraoperative MR imaging in a case of a cervical spinal cord lesion

2011 ◽  
Vol 14 (6) ◽  
pp. 754-757 ◽  
Author(s):  
David Netuka ◽  
Svatopluk Ostrý ◽  
Tomáš Belšán ◽  
Filip Kramář ◽  
Vladimír Beneš
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Cervical Pain ◽  
Neck Flexion ◽  
Before And After ◽  
Cord Lesion

The aim of this article is to describe the feasibility of performing intraoperative MR imaging in patients with spinal cord lesions and the potential value of this technique. The authors report a case involving a 28-year-old man who presented with chronic cervical pain and pain along the ulnar side of the forearms during neck flexion. Findings on clinical examination were normal, but MR imaging revealed a multicystic cervical spinal cord lesion. Surgery was undertaken to open the cysts, evacuate old blood, and search for pathological tissue. Intraoperative MR imaging showed that the caudal cyst was not opened, and surgery was therefore continued. The caudal cyst was fenestrated and a suspected small cavernous malformation was removed. Electrophysiological monitoring was performed both before and after the intraoperative MR imaging. The use of intraoperative MR imaging changed the strategy of the procedure and helped the surgeon to safely enter all the cysts in the cervical cord.

scholarly journals Microsurgical resection of symptomatic intramedullary cervical spinal cord cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V12
Author(s):  
Tomasz A. Dziedzic ◽  
Andrzej Marchel
Keyword(s):  
Spinal Cord ◽  
Postoperative Morbidity ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Significant Risk ◽  
Neural Tissue ◽  
Complete Resection ◽  
Surgical Removal ◽  
Cavernous Malformations ◽  
Microsurgical Resection

Intramedullary cavernous malformations account for approximately 5% of all intraspinal lesions. Symptomatic lesions are treated with microsurgical resection. Due to surrounding eloquent spinal neural tissue, surgical removal of these lesions can be technically challenging. Surgical treatment carries a significant risk for postoperative morbidity. This video demonstrates the main steps for the microsurgical technique of resection of a symptomatic intramedullary cervical spinal cord cavernous malformation at the C2–3 level. Complete resection was achieved with minimal posterior column deficit. The operative technique and surgical nuances, including the patient’s positioning, surgical approach, intraspinal cavernous malformation removal, and closure, are illustrated.The video can be found here: https://youtu.be/UKttTiXlEb8.

scholarly journals Left Interhemispheric Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E154-E154
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Lateral Ventricle ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Mass Effect ◽  
Cavernous Malformations ◽  
Transcallosal Approach ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract Thalamic cavernous malformations pose variable surgical challenges given that the location and size of the lesion often determine the approach surgical trajectory. The patient in this case has a large thalamic cavernous malformation that results in a mass effect on the third ventricle and directly abuts the lateral ventricle. A small interhemispheric craniotomy is performed to allow for an anterior interhemispheric transcallosal approach to the lesion. The lateral ventricle is accessed, and the septum is removed to enhance visualization of the surgical field. A small rim of normal parenchyma on the lateral margin of the thalamus is transgressed, and the cavernous malformation is entered. The lesion is removed in a piecemeal manner. Use of counter traction assists with the piecemeal removal. The lighted suction is critical during inspection and manipulation of the lesion within the resection cavity given the limited lighting deep within the cavity. The lesion was removed completely, and postoperative imaging confirms gross total resection. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute.

scholarly journals Far-Lateral Approach for Medullary Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (3) ◽  
pp. E74-E75
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Lateral Approach ◽  
Cavernous Malformations ◽  
Institutional Review ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Caudal Medulla ◽  
High Degree ◽  
Selection Of

Abstract Medullary cavernous malformations are the rarest subtype of brainstem cavernous malformation and are associated with a high degree of morbidity. Selection of surgical candidates is critical, and cases are most favorable when the cavernous malformation abuts the surface of the brainstem. This limits the amount of native tissue transgressed during the resection. This patient had a large cavernous malformation within the caudal medulla eccentric. A right-sided paramedian far-lateral approach was used to access the brainstem. The cavernous malformation was readily apparent along the medullary surface and was dissected away in its entirety. Postoperative imaging confirmed complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Parietooccipital Transventricular Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E149-E150 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Stereotactic Navigation ◽  
Surgical Field ◽  
Transcortical Approach

Abstract The highly eloquent nature of the thalamus and the depth of the surgical field make thalamic cavernous malformations exceptionally challenging entities for surgical management, necessitating stereotactic navigation and lighted instruments for successful resection. This case demonstrates a patient with a large right dorsal thalamic cavernous malformation that is approached using the well-tolerated transparietooccipital lobule approach for ventricular access and subsequent resection of the lesion along the intraventricular surface. Stereotactic neuronavigation permits this transcortical approach with minimal transgression of normal parenchyma. The trajectory permits approach to the cavernous malformation along its greatest dimension to augment removal. A complete removal of the lesion is achieved. The patient remained at neurological baseline postoperatively. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Sign in / Sign up

Export Citation Format

Share Document