Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

scholarly journals Resection of brainstem cavernous malformation via perifacial zone through retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (1) ◽  
pp. V16 ◽  
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Senior Author ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Inferior Surface ◽  
Complete Surgical Resection ◽  
Brainstem Cavernoma ◽  
Dissection Techniques ◽  
Pontomedullary Junction

Hemorrhagic brainstem cavernous malformations carry a high risk of progressive neurological deficits owing to recurrent hemorrhages and hence require complete surgical resection while minimizing damage to the dense concentration of nuclei and fibers inside the brainstem. To access lesions inside the lower pons, the senior author (H.B.) has preferred to approach the lesions via the “perifacial zone” through the pontomedullary sulcus from the inferior surface of the pontine bulge for more than 20 years.1,2 This video demonstrates a case of a cavernous malformation inside the lower pons, which was surgically treated via the pontomedullary junction through the retrosigmoid supracondylar approach in a half-sitting position. The lesion was completely removed in piecemeal fashion through a tiny incision on the sulcus, which did not cause any new neurological deficits. The modified Rankin Scale improved from 4 before the surgery to 1, and the patient had no recurrence during the 2 years of follow-up. The advantage of this access and the dissection techniques for this challenging lesion are introduced, based on our experience with more than 230 surgeries of brainstem cavernoma.The video can be found here: https://youtu.be/0H_XqkQgQ9I.

scholarly journals Microsurgical resection of a large cavernous malformation of the medulla oblongata

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.

Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

2019 ◽  
Vol 1 (2) ◽  
pp. V3
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Duarte N. C. Cândido ◽  
Wladimir O. Melo ◽  
Marcio S. Rassi ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Three Dimensional ◽  
Foramen Magnum ◽  
Complete Resection ◽  
Neurophysiological Monitoring ◽  
Cervical Instability ◽  
Transcondylar Approach ◽  
Postoperative Mri ◽  
Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

scholarly journals Surgical Experience in Pediatric Patients with Chiari-I Malformations Aged ≤18 Years

2019 ◽  
Vol 10 (01) ◽  
pp. 85-88 ◽  
Author(s):  
Ghanshyam Das Singhal ◽  
Shakti Singhal ◽  
Gunjan Agrawal ◽  
Deepti Singhal ◽  
Vipin Arora
Keyword(s):  
Pediatric Patients ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Surgical Experience ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Chiari I

ABSTRACT Objective: The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically. Materials and Methods: Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied. Results: During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30). Conclusions: The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice.

Surgical management of giant pediatric craniopharyngiomas

2010 ◽  
Vol 6 (5) ◽  
pp. 403-416 ◽  
Author(s):  
Robert E. Elliott ◽  
Jeffrey H. Wisoff
Keyword(s):  
Disease Control ◽  
Functional Outcomes ◽  
Visual Fields ◽  
Radical Resection ◽  
Neurological Complications ◽  
Senior Author ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Recurrent Tumors

Object Prior work by the authors' group and reports of other authors suggest worse functional outcomes and decreased survival in children with larger craniopharyngiomas. The purpose of this study was to assess the oncological, endocrinological, and functional outcomes in children who underwent radical resection of giant craniopharyngiomas (defined as 5 cm or greater in largest diameter). Methods Between 1986 and 2006, 26 children under the age of 18 (14 boys, 12 girls; mean age 10.5 years) underwent radical resection of giant craniopharyngiomas performed by the senior author. Data were retrospectively collected to assess the outcome of surgical treatment. Results Twenty (77%) of 26 patients underwent gross-total resection (GTR) confirmed by intraoperative inspection and postoperative imaging. All primary tumors (17 of 17) and 3 (33%) of 9 recurrent tumors were treated with GTR. There was no operative mortality, and 18 of 26 patients (69%) were alive at a mean follow-up of 8.9 years (median 9.3 years). Disease control was achieved in 21 (84%) of the 25 patients followed up for more than 6 months and was more successful in patients who underwent GTR (95%) than in those who underwent STR (50%, p = 0.03). New-onset diabetes insipidus (DI) occurred in 63.2% of patients (73% of patients had DI postoperatively). New or worsened deficits in visual acuity and visual fields occurred in 16% and 28%, respectively, of the 25 patients for whom postoperative visual data were available. Five patients (19%) experienced significant, permanent neurological deficits, and 5 (19%) had mild to moderate deficits. New or worsened hypothalamic disturbance occurred in 35% and 22% of patients, respectively, but obesity developed in only 15%. Conclusions In this retrospective series, radical resection of giant craniopharyngiomas in children was found to lead to excellent rates of disease control with acceptable or good functional outcomes but slightly higher rates of neurological complications compared with rates in patients with smaller tumors. Radical resection is less successful in recurrent tumors that reach very large sizes, especially previously irradiated tumors, with resultant diminished survival.

scholarly journals Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

2013 ◽  
Vol 71 (4) ◽  
pp. 220-228 ◽  
Author(s):  
Marcelo Campos Moraes Amato ◽  
João Flávio Gurjão Madureira ◽  
Ricardo Santos de Oliveira
Keyword(s):  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Study Group ◽  
Functional Evaluation ◽  
Cavernous Malformations ◽  
Asymptomatic Patients ◽  
The Mean

Objectives: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. Methods: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. Results: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. Conclusions: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.

SURGERY FOR CONVEXITY MENINGIOMAS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 427-434 ◽  
Author(s):  
Andrew P. Morokoff ◽  
Jacob Zauberman ◽  
Peter M. Black
Keyword(s):  
Recurrence Rate ◽  
Malignant Tumors ◽  
Surgical Techniques ◽  
Senior Author ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Complete Excision ◽  
Image Guided

ABSTRACT OBJECTIVE Meningiomas that occur over the convexity of the brain are the most common meningiomas, but little has been published about their contemporary management. We aimed to analyze a large series of convexity meningiomas with respect to surgical technique, complication rates, and pathological factors leading to recurrence. METHODS We retrospectively reviewed 163 cases of convexity meningiomas operated on in our institution by the senior author (PMB) between 1986 and 2005. The median follow-up time was 2.3 years (range, 1–13 yr). RESULTS Convexity tumors represented 22% of all meningiomas operated on. There was a female:male ratio of 2.7:1. Median age was 57 years (range, 20–89 yr). Image-guided surgery was used on all cases in the last 5 years. The 30-day mortality rate was 0%. The incidence of new neurological deficits was 1.7%, and the overall complication rate was 9.4%. The pathology of the tumors was benign in 144 (88.3%), atypical in 16 (9.8%), and anaplastic/malignant in 3 (1.8%). In six of the cases designated “benign,” there were borderline atypical features. The 5-year recurrence rate for benign meningiomas was 1.8%, atypical meningiomas 27.2%, and anaplastic meningiomas 50%. The two cases of benign tumor recurrences involved tumors with borderline atypia and high MIB-1 indices. The borderline atypical cases had a 5-year recurrence-free survival rate of only 55.9%, more closely approximating that of tumors designated “atypical.” CONCLUSION Convexity meningiomas can be safely removed using modern image-guided minimally invasive surgical techniques with a very low operative mortality. Benign convexity meningiomas having a Simpson Grade I complete excision have a very low recurrence rate. The recurrence rates of atypical and malignant tumors are significantly higher, and borderline atypical tumors should be considered to behave more like atypical rather than benign lesions. Longer-term follow-up data are needed to more accurately determine the recurrence rates of benign meningiomas.

Foramen magnum tumors

1978 ◽  
Vol 49 (6) ◽  
pp. 828-838 ◽  
Author(s):  
Shozo Yasuoka ◽  
Haruo Okazaki ◽  
Jasper R. Daube ◽  
Collin S. MacCarty
Keyword(s):  
Cervical Spondylosis ◽  
Clinical Presentation ◽  
Functional Results ◽  
Normal Pressure ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Intramedullary Tumor ◽  
Content Type ◽  
Tunnel Syndrome

✓ This study involved 57 patients with benign extramedullary tumors of the foramen magnum (19 neurinomas, 37 meningiomas, and one teratoma), who were operated on between 1957 and 1976. The 37 meningiomas represented 3.2% of 1139 meningiomas of the neuraxis. The initial neurological examinations of about half of these patients were unremarkable. The clinical presentation of tumors of the foramen magnum frequently mimics multiple sclerosis, cervical spondylosis, intramedullary tumor, syrinx, carpal tunnel syndrome, and even normal-pressure hydrocephalus. All operations were performed through a posterior approach, and two surgical deaths (3.5%) were recorded. No surgery for recurrence of tumor was recorded. The follow-up review of 56 patients (98.2%) showed good functional results if the tumor was detected before severe neurological deficits occurred. The possible mechanism of the sensory symptoms and muscle atrophy of the hands is discussed, and the electromyographic findings are reviewed.

Avulsion Fracture of the Foramen Magnum Treated with Occiput-to-C1 Fusion: Technical Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. E600-E600 ◽  
Author(s):  
Peter H. Maughan ◽  
Eric M. Horn ◽  
Nicholas Theodore ◽  
Iman Feiz-Erfan ◽  
Volker K.H. Sonntag
Keyword(s):  
Avulsion Fracture ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Rare Injury ◽  
Computed Tomographic ◽  
Inferior Aspect ◽  
Lateral Mass Screws ◽  
Occipital Condyles ◽  
Neurologically Intact

ABSTRACT OBJECTIVE AND IMPORTANCE: A 31-year-old woman presented with an avulsion fracture of the foramen magnum via bilateral occipital condyles with extension through the inferior aspect of the clivus. CLINICAL PRESENTATION: The patient had no neurological deficits and was initially immobilized in a halo brace. INTERVENTION: To preserve rotational motion at C1–C2, we performed an occiput-to-C1 fusion with bilateral C1 lateral mass screws attached with rods to occipital keel screws. Postoperatively, the patient remained neurologically intact. Three-month follow-up imaging revealed no abnormal motion. Follow-up computed tomographic scan showed an intact construct and bony fusion. CONCLUSION: This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.

scholarly journals Extended Retrosigmoid Approach for the Resection of a Pontomedullary Junction Cavernous Malformation

2018 ◽  
Vol 79 (S 05) ◽  
pp. S418-S419
Author(s):  
Jaafar Basma ◽  
Vincent Nguyen ◽  
Jeffrey Sorenson ◽  
L. Michael
Keyword(s):  
Cerebellopontine Angle ◽  
Cavernous Malformation ◽  
Cranial Nerves ◽  
Extent Of Resection ◽  
Senior Author ◽  
Retrosigmoid Approach ◽  
Microsurgical Anatomy ◽  
Brainstem Cavernoma ◽  
Lateral Decubitus ◽  
Pontomedullary Junction

Objectives To describe an extended retrosigmoid approach for the resection of a cavernoma involving the ponto-medullary junction, with emphasis on the microsurgical anatomy and technique. Design A retrosigmoid craniotomy is performed in the lateral decubitus position and the sigmoid sinus exposed. After opening the dura, sutures are placed medial to the sinus to allow its gentle mobilization. Cerebrospinal fluid (CSF) is drained from the cisterna magna, and cerebellopontine cistern, and dynamic retraction is used over the cerebellum. Subarachnoid dissection of the cerebellopontine angle gives access to cranial nerves IX/X, VII/VIII, and VI. Inspection of the pontomedullary junction medial to the facial nerve reveals hemosiderin staining in that region. A small pial opening is made, exposing the hemorrhagic cavity. The cavernous malformation is then identified, dissected circumferentially, and resected. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior author performed the surgery. The video was edited by Drs. J.B. and V.N. Outcome Measures Outcome was assessed with extent of resection and postoperative neurological function. Results A gross total resection of the lesion was achieved. The patient did not develop any postoperative deficits. Conclusion Understanding the microsurgical anatomy of the cerebellopontine angle and meticulous microneurosurgical technique are necessary to achieve a complete resection of a brainstem cavernoma. The extended retrosigmoid approach provides an adequate corridor to the pontomedullary junction.The link to the video can be found at: https://youtu.be/FIKixWJT75w.

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