Microsurgical Resection of a Middle Cerebellar Peduncle Cavernous Malformation: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E170-E171
Author(s):  
Marcio S Rassi ◽  
Guilherme H W Ceccato ◽  
Emerson Schindler ◽  
Felipe G Fagundes ◽  
Matias N P Beiras ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Neurophysiological Monitoring ◽  
En Bloc ◽  
Complete Excision ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Initial Symptoms ◽  
Telovelar Approach ◽  
Cerebellar Peduncle ◽  
The Right

Abstract Brainstem cavernous malformations are frequently surrounded by vital structures, which often makes surgical treatment a challenging task even to the most skilled surgeon. Accordingly, microsurgical excision is preferably offered to symptomatic patients and superficial lesions.1-3 We present the case of a 41-yr-old male presenting with progressive dizziness and diplopia. Neurological examination showed horizontal nystagmus, dysmetria, and unbalance. Preoperative magnetic resonance imaging (MRI) suggested a cavernous malformation in the right middle cerebellar peduncle. A telovelar approach was employed with the guidance of intraoperative neurophysiological monitoring. An exophytic lesion was identified in the right middle cerebellar peduncle and a clear cleavage plane was obtained allowing circumferential dissection around the capsule. The lesion was removed en bloc. Postoperative MRI confirmed a complete excision of the malformation. The patient presented an improvement in his initial symptoms, with no new neurological deficit. Cavernous malformations related with the fourth ventricle can be successfully resected through a telovelar approach in select cases, especially when exophytic, where the surgeon might take advantage of the path created by the lesion. Informed consent was obtained from the patient for the procedure and publication of this operative video. Anatomic images were a courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).

scholarly journals Microsurgical resection of an inferior cerebellar peduncle cavernous malformation: 3-Dimensional operative video

2019 ◽  
Vol 1 (1) ◽  
pp. V22
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Julia Goginski ◽  
Pedro H. A. da Silva ◽  
Gabriel S. de Fraga ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Neurophysiological Monitoring ◽  
Cavernous Malformations ◽  
3 Dimensional ◽  
Initial Symptoms ◽  
Intimate Relation ◽  
Microsurgical Resection ◽  
Cerebellomedullary Fissure ◽  
Cerebellar Peduncle ◽  
Inferior Cerebellar Peduncle

Brainstem cavernous malformations are especially difficult to treat because of their deep location and intimate relation with eloquent structures. This is the case of a 26-year-old female presenting with dizziness, dysmetria, nystagmus and unbalance. Imaging depicted a lesion highly suggestive of a cavernous malformation in the left inferior cerebellar peduncle. Following a suboccipital midline craniotomy, the cerebellomedullary fissure was dissected and the lesion was identified bulging the surface. The malformation was completely removed with constant intraoperative neurophysiological monitoring. The patient presented improvement of initial symptoms with no new deficits. Surgical resection of brainstem cavernous malformations can be successfully performed, especially when superficial, using the inferior cerebellar peduncle as an entry zone.The video can be found here: https://youtu.be/-GGZe_CaZnQ.

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.

Left retrosigmoid craniotomy for cavernous malformation of the middle cerebellar peduncle

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Jonathan Russin ◽  
David J. Fusco ◽  
Robert F. Spetzler
Keyword(s):  
Cerebrospinal Fluid ◽  
Cavernous Malformation ◽  
Lateral Wall ◽  
Petrous Bone ◽  
Sigmoid Sinus ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Lateral Border ◽  
History Of ◽  
Cerebellar Peduncle

We present a 25-year-old female with a history of multiple intracranial cavernous malformations complaining of vertigo. Imaging is significant for increasing size of a lesion in her left cerebellar peduncle. Given the proximity to the lateral border of the cerebellar peduncle, a retrosigmoid approach was chosen. After performing a craniotomy that exposed the transverse-sigmoid sinus junction, the dura was open and reflected. The arachnoid was sharply opened and cerebrospinal fluid was aspirated to allow the cerebellum to fall away from the petrous bone. The cerebellopontine fissure was then opened to visualize the lateral wall of the cerebellar peduncle. The cavernous malformation was entered and resected.The video can be found here: http://youtu.be/P7mpVbaCiJE.

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

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.

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

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.

Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation

2012 ◽  
Vol 16 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Mark E. Oppenlander ◽  
M. Yashar S. Kalani ◽  
Curtis A. Dickman
Keyword(s):  
Peripheral Nerves ◽  
Cavernous Malformation ◽  
Relevant Literature ◽  
Spinal Fixation ◽  
Nerve Roots ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Cavernous Malformations ◽  
Intradural Extramedullary ◽  
The Right

Cavernous malformations (CMs) are found throughout the CNS but are relatively uncommon in the spine. In this report, the authors describe a giant CM with the imaging appearance of an aggressive, invasive, expansive tumor in the cervical spine. The intradural extramedullary portion of the tumor originated from a cervical nerve root; histologically, the lesion was identified as an intraneural CM. Most of the tumor extended into the paraspinal tissues. The tumor was also epidural, intraosseous, and osteolytic and had completely encased cervical nerve roots, peripheral nerves, branches of the brachial plexus, and the vertebral artery on the right side. It became symptomatic during the puerperal period. Gross-total resection was achieved using staged operative procedures, complex dural reconstruction, spinal fixation, and fusion. Clinical, radiographic, and histological details, as well as a discussion of the relevant literature, are provided.

Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation

2014 ◽  
Vol 121 (3) ◽  
pp. 723-729 ◽  
Author(s):  
Vivek R. Deshmukh ◽  
Leonardo Rangel-Castilla ◽  
Robert F. Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Case Series ◽  
Cavernous Malformations ◽  
Excellent Outcome ◽  
Suboccipital Craniotomy ◽  
Scale Scores ◽  
Far Lateral ◽  
Cerebellar Peduncle ◽  
Inferior Cerebellar Peduncle ◽  
Foramen Of Luschka

Object Brainstem cavernous malformations (BSCMs) present a unique therapeutic challenge to neurosurgeons. Resection of BSCMs is typically reserved for lesions that reach pial or ependymal surfaces. The current study investigates the lateral inferior cerebellar peduncle as a corridor to dorsolateral medullary BSCMs. Methods In this retrospective review, the authors present the cases of 4 patients (3 women and 1 man) who had a symptomatic dorsolateral cavernous malformation with radiographic and clinical evidence of hemorrhage. Results All patients underwent excision of the cavernous malformation via a far-lateral suboccipital craniotomy through the foramen of Luschka and with an incision in the inferior cerebellar peduncle. On intraoperative examination, 2 of the 4 patients had hemosiderin staining on the surface of the peduncle. All lesions were completely excised and all patients had a good or excellent outcome (modified Rankin Scale scores of 0 or 1). Conclusions This case series illustrates that intrinsic lesions of the dorsolateral medulla can be safely removed laterally through the foramen of Luschka and the inferior cerebellar peduncle.

scholarly journals Resection of pontine cavernous malformation by the full neuroendoscopic telovelar approach

2021 ◽  
Author(s):  
qiang cai ◽  
Yuyong Ke ◽  
Baowei Ji ◽  
Zhiyang Li ◽  
Wenju Wang ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Degree Of Freedom ◽  
Posterior Arch ◽  
Cavernous Malformations ◽  
Pontine Tegmentum ◽  
Telovelar Approach

Abstract Introduction: Lesions located in the fourth ventricle and/or pontine tegmentum were treated by telovelar approach under a microscope. However, it is difficult to access upper fourth ventricle from caudal to rostral without removal posterior arch of the atlas due to the vertical working angle of microscope. Neuroendoscope has a good degree of freedom in surgery and can reach this area easily. We tried to remove pontine cavernous malformation by full neuroendoscopic telovelar approach and the results was excellent. Clinical Presentation: Two women presented with dizziness and numbness and were diagnosed as pontine cavernous malformation. The cavernous malformations were removed by a full neuroendoscopic telovelar approach without removal of the posterior arch of the atlas. Conclusion: Neuroendoscope can remedy the flaws of microscopy and can provide greater application for the telovelar approach in pons and fourth ventricle.

Lateral Myelotomy for Resection of a Ruptured Intramedullary Cervico-Thoracic Cavernous Malformation

2020 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Yehuda Herschman ◽  
Nitesh V Patel ◽  
Fareed Jumah ◽  
Zhenggang Xiong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Lateral Approach ◽  
Sudden Onset ◽  
Sensory Loss ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Motor Weakness ◽  
Left Lower Extremity ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Intramedullary spinal cord cavernous malformations represent 5% to 12% of spinal vascular disease. Most patients present with acute or progressive neurological symptoms, including motor weakness or sensory loss. Surgical resection is the only definitive management and is recommended for symptomatic lesions that are surgically accessible. CLINICAL PRESENTATION A 35-yr-old woman presented with a sudden onset of pain and temperature sensation loss in the left lower extremity. Magnetic resonance imaging of the spine showed a hemorrhage located ventral and slightly lateral to the right of the midline of the spinal cord from C7 through T3. Ultimately, a right lateral myelotomy between the ventral and dorsal roots was performed, and the cavernous malformation was removed. Postoperative imaging confirmed gross total resection of the cavernous malformation. CONCLUSION In this article, we report a highly unusual case of a multisegment, ruptured intramedullary cavernous malformation that was ultimately resected through a lateral myelotomy approach. This case demonstrates that a lateral approach to the spinal cord substance can be utilized for ruptured cavernous malformation, especially if there is hemorrhage at the surface of the spinal cord. This can be used as an entry into the anterolateral compartment of the spinal cord, which would otherwise be regarded as a highly morbid approach due to the sensory deficits induced. We believe this entry point to the spinal cord is feasible in highly select cases such as this.

De Novo Development of a Cavernous Malformation of the Brain: Significance of Factors with Paracrine and Endocrine Activity: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 646-650 ◽  
Author(s):  
Wolf Lüdemann ◽  
Verena Ellerkamp ◽  
Alexandru C. Stan ◽  
Sami Hussein
Keyword(s):  
Hormone Receptors ◽  
De Novo ◽  
Cavernous Malformation ◽  
Pituitary Hormones ◽  
Surrounding Tissue ◽  
Endocrine Activity ◽  
Cavernous Malformations ◽  
Computed Tomographic ◽  
The Right ◽  
The Brain

Abstract OBJECTIVE AND IMPORTANCE: De novo development of cavernous malformations is poorly documented in the literature. CLINICAL PRESENTATION: We report the case of a 37-year old woman with de novo growth of a cavernous malformation of the brain. The patient presented with a 12-month history of nonspecific headaches and paresthesias after two pregnancies. After computed tomographic scanning of the cranium, a cavernous malformation located parieto-occipitally within the right brain hemisphere was diagnosed. Control magnetic resonance imaging scans obtained 12 years earlier did not reveal a similar lesion. INTERVENTION: Surgery was performed, and the specimen was analyzed histopathologically. CONCLUSION: Immunohistochemistry demonstrated lack of expression of pituitary hormones as well as of androgen, estrogen, and progesterone hormone receptors. However, strong expression of both basic fibroblast growth factor and CD44 was detected in surrounding tissue, and expression of CD44 was noted within the matrix of the cavernous malformation.

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