scholarly journals Pontine cavernous malformation: microsurgery evading the floor of the fourth ventricle

2019 ◽  
Vol 1 (1) ◽  
pp. V15
Author(s):  
Abdullah Keleş ◽  
Mehmet Volkan Harput ◽  
Uğur Türe
Keyword(s):  
Fourth Ventricle ◽  
Cavernous Malformation ◽  
Total Resection ◽  
Middle Cerebellar Peduncle ◽  
Link Type ◽  
Postoperative Mri ◽  
First Choice ◽  
Cerebellar Peduncle ◽  
Neurologically Intact

This video demonstrates resection of a left pontine cavernous malformation that is abutting the floor of the fourth ventricle (f4V). Even though accessing the lesion through the f4V seems to be reasonable, we used a lateral supracerebellar approach through the middle cerebellar peduncle to preserve especially the abducens and facial nuclei. After total resection the patient was neurologically intact at the 3-month follow-up. Postoperative MRI revealed 3.5-mm pontine tissue between the cavity and f4V that appeared to be absent in preoperative MRI. Approaching pontine lesions through the f4V is not the first choice. In our opinion, the philosophy of safe entry zones is a concept to be reassessed.The video can be found here: https://youtu.be/1Jh6giZc-48.

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.

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

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.

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.

scholarly journals Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma

2019 ◽  
Vol 1 (1) ◽  
pp. V2
Author(s):  
Matteo Zoli ◽  
Giacomo Sollini ◽  
Sofia Asioli ◽  
Clarissa Ann Elisabeth Gelmi ◽  
Angelo Gianluca Corradini ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Cavernous Malformation ◽  
Cavernous Angioma ◽  
Radical Resection ◽  
Total Removal ◽  
Link Type ◽  
Neurologically Intact

We present the case of a 47-year-old man with left exophthalmus. MRI showed a left intraorbital intraconal cavernous malformation, located in the superoesternal quadrant and medially displacing the optic nerve. An endoscopic transpalpebral approach was performed and total removal was achieved after dissection of the lesion from the optic nerve and other orbital structures. Pathology confirmed the diagnosis of cavernous malformation. The patient was discharged neurologically intact on the second postoperative day free of complications. Follow-up MRI demonstrated radical resection of the cavernoma and resolution of the exophthalmus with an excellent esthetic result.The video can be found here: https://youtu.be/o1a1tneZ6qk.

scholarly journals Retrosigmoid Approach for Resection of Cerebellar Peduncle Cavernoma

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.

scholarly journals Microscopic resection of a giant epidermoid tumor of the pineal region via supracerebellar infra and transtentorial approach with endoscope assistance

2021 ◽  
Vol 5 (1) ◽  
pp. V7
Author(s):  
Marco Antônio Zanini ◽  
Aderaldo Costa Alves Junior ◽  
Fabio Pires Botta ◽  
Haniel Moraes Serpa Nascimento ◽  
Pedro Tadao Hamamoto Filho
Keyword(s):  
Surgical Approach ◽  
Pineal Region ◽  
Microscopic Technique ◽  
Epidermoid Tumor ◽  
Link Type ◽  
Postoperative Mri ◽  
Neurologically Intact ◽  
Transtentorial Approach

The authors present a case of a 22-year-old male who developed hydrocephalus symptoms related to a giant epidermoid tumor at the pineal region. The surgical approach and technique for a large epidermoid tumor in this area are extensively discussed. A paramedian contralateral supracerebellar infratentorial and transtentorial approach was performed, with the patient in a semisitting position. The tumor was removed using a microscopic technique, and endoscope assistance was used in order to reach the areas unable to be visualized under the microscope. The patient was neurologically intact at his 2-year follow-up, and postoperative MRI showed a significant decrease in the tumoral volume. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2128.

Resection of pontine cavernous malformation through the pontomedullary sulcus

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1
Author(s):  
Adib Adnan Abla ◽  
Aaron J. Clark ◽  
Michael T. Lawton
Keyword(s):  
Nerve Palsy ◽  
Cavernous Malformation ◽  
Abducens Nerve ◽  
Temporary Increase ◽  
Total Resection ◽  
Middle Cerebellar Peduncle ◽  
Far Lateral ◽  
Cerebellar Peduncle ◽  
12Th Cranial Nerve ◽  
Olivary Nucleus

In this video, we illustrate a right far-lateral craniotomy for resection of a 13-mm cavernous malformation of the pons in a healthy 53-year-old female patient presenting with diplopia and right 6th nerve palsy. The cavernous malformation was surrounded by normal pons, but was within 1 mm of the pontomedullary sulcus. The lesion was exposed from below through a far lateral craniotomy and accessed through the vasoaccessory triangle, superior to olivary nucleus and 12th cranial nerve. The alternative retrosigmoid craniotomy would have involved significant transgression of the middle cerebellar peduncle. The patient had gross-total resection and some temporary increase in her abducens nerve palsy without any complication.The video can be found here: http://youtu.be/f14RR3CHQkw.

Medulla oblongata cavernoma removal through a lazy far lateral approach: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V21
Author(s):  
Carlos Candanedo ◽  
Samuel Moscovici ◽  
Sergey Spektor
Keyword(s):  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Complete Removal ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Total Resection ◽  
Postoperative Mri ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Brainstem Cavernous Malformation

Removal of brainstem cavernous malformation remains a surgical challenge. We present a case of a 63-year-old female who was diagnosed with a large cavernoma located in the medulla oblongata. The patient suffered three episodes of brainstem bleeding resulting in significant neurological deficits (hemiparesis, dysphagia, and dysarthria). It was decided to remove the cavernoma through a left-sided modified far lateral approach.3The operative video demonstrates the surgical steps and nuances of a complete removal of this complex medulla oblongata cavernous malformation. Total resection was achieved without complications. Postoperative MRI revealed no signs of residual cavernoma with clinical improvement.The video can be found here: https://youtu.be/BTtMvvLMOFM.

scholarly journals Expanded Transsphenoidal Trans-Lamina Terminalis Approach to Tumors Extending Into the Third Ventricle: Technique Notes and a Single Institute Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Lei Cao ◽  
Wentao Wu ◽  
Jie Kang ◽  
Hui Qiao ◽  
Xiaocui Yang ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Radical Resection ◽  
Lamina Terminalis ◽  
Total Resection ◽  
The Third ◽  
Cerebrospinal Fluid Leaks ◽  
Ventricular Tumors ◽  
New Onset

ObjectThe trans lamina terminalis approach (TLTA) has been described as a way to remove third ventricular tumors. The aim of this paper was to analyze the feasible outcomes of TLTA applied to tumors extending into the third ventricle in our institute.MethodsSuprasellar tumors (n = 149) were treated by the extended endonasal approach from September 2019 to December 2020 in Beijing Tiantan Hospital. Eleven of the tumors were treated by TLTA or TLTA via the trans-chiasm-pituitary corridor (TCPC). The surgical technique notes of TLTA were described and indications and outcomes of the approach were analyzed.ResultsThere were 11 patients enrolled in the study, six with papillary craniopharyngiomas, two with adamantinomatous craniopharyngiomas, one with a germinal cell tumor (GCT), one with cavernous malformation and one with chordoid glioma. Four of the patients received a radical resection by TLTA alone, while seven of them received TLTA via the TCPC. Gross total resection was achieved in eight patients (72.7%), and partial resection in three patients (27.3%). Visual function was improved in four of the 11 patients (36.4%), was unchanged in five patients (45.5%), and deteriorated in two patients (18.2%). New-onset hypopituitarism occurred in seven patients (63.3%) and new-onset diabetes insipidus occurred in two patients (18.2%). Electrocyte imbalance were observed in six patients (54.5%) at post-operative week 2. There were no surgery-related deaths or cerebrospinal fluid leaks. Postoperative intracranial infection was observed in one patient (9.1%), and during the follow-up period, tumor recurrence occurred in one patient (9.1%).ConclusionThe expanded TLTA provides a feasible suprachiasm corridor to remove tumors extending into the third ventricle, especially for craniopharyngiomas. Sound understanding of the major strengths and limitations of this approach, as well as strategies for complication avoidance, is necessary for its safe and effective application.

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.

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