Bilateral Wallerian Degeneration of the Middle Cerebellar Peduncle and Unilateral Hypertrophic Olivary Degeneration Secondary to Pontine Hemorrhage: A Case Report

Background. Wallerian degeneration in pyramidal tract following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the Wallerian degeneration in middle cerebellar peduncle after pontine infarction and its potential clinical significance remain to be confirmed. Methods. Seventeen patients with a recent focal pontine infarct underwent 3 DTIs at week 1 (W1), week 4 (W4), and week 12 (W12) after onset. Seventeen age-matched and gender-matched controls underwent DTI one time. Mean diffusivity and fractional anisotropy (FA) were measured in the basis pontis and bilateral middle cerebellar peduncles. Neurological deficit, motor deficit, functional independence, and limbs ataxia were assessed with the National Institutes of Health (NIH) Stroke Scale, Fugl-Meyer scale, Barthel Index, and the second part of International Cooperative Ataxia Rating Scale. Results. FA values at the bilateral middle cerebellar peduncles decreased significantly from W1 to W12 progressively ( P < .01). The patients improved on the NIH Stroke Scale, Fugl-Meyer scale, and Barthel Index over time ( P < .01). Greater absolute value of percentage reduction of FA at the bilateral middle peduncles, however, was associated with the less absolute value of percentage reduction of the NIH Stroke Scale and less increase in the Fugl-Meyer scale, as well as greater ataxia over time. Conclusions. Wallerian degeneration in the middle cerebellar peduncle revealed by DTI may hinder the process of neurological recovery following a focal pontine infarct.

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Hypertrophic Olivary Degeneration After Pontine Hemorrhage: A Case Report

Journal of Clinical Case Reports ◽

10.4172/2165-7920.1000762 ◽

2016 ◽

Vol 06 (04) ◽

Author(s):

Yingxin Yu ◽

Xiaokun Qi

Keyword(s):

Case Report ◽

Hypertrophic Olivary Degeneration ◽

Pontine Hemorrhage

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Lateral Transpeduncular Approach to Intrinsic Lesions of the Rostral Pons

Operative Neurosurgery ◽

10.1227/01.neu.0000350865.85697.18 ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-26-ons-29 ◽

Cited By ~ 4

Author(s):

Matthew O. Hebb ◽

Robert F. Spetzler

Keyword(s):

Patient Outcomes ◽

Cavernous Malformation ◽

Candidate Selection ◽

Illustrative Case ◽

Surgical Indications ◽

Middle Cerebellar Peduncle ◽

Independent State ◽

Pontine Hemorrhage ◽

Bulbar Symptoms ◽

Cerebellar Peduncle

Abstract Objective: We describe the lateral transpeduncular approach to access lesions in the rostral pons. The surgical indications and technique are discussed in the context of an illustrative case and pertinent anatomic considerations. Methods: A 38-year-old man with acute right hemiparesis and bulbar symptoms had a left pontine hemorrhage with an associated cavernous malformation and venous anomaly. There was no pial or ependymal representation of the lesion. To avoid disruption of eloquent structures, the pia was entered in the posterolateral aspect of the middle cerebellar peduncle. Subsequent dissection was guided by stereotactic neuronavigation in a ventromedial trajectory along the course of the pontocerebellar fibers. Results: The cavernous malformation was resected completely without procedure-related morbidity. The patient’s preoperative deficits slowly improved to a functionally independent state. Conclusion: The lateral transpeduncular approach may be used to access intrinsic lesions of the rostral pons with relatively low morbidity. Stereotactic neuronavigation and intra-operative electrophysiological monitoring are important surgical adjuncts to guide dissection and lesion extirpation. Candidate selection, microsurgical technique, and pragmatic treatment goals remain fundamental to optimal patient outcomes.

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Bilateral Hypertrophic Olivary Degeneration after Pontine Hemorrhage: A Case Report

World Journal of Clinical Cases ◽

10.12998/wjcc.v10.i1.289 ◽

2022 ◽

Vol 10 (1) ◽

pp. 289-295

Author(s):

Bo Zheng ◽

Jian Wang ◽

Xue-Qiong Huang ◽

Zhao Chen ◽

Gang-Feng Gu ◽

...

Keyword(s):

Case Report ◽

Hypertrophic Olivary Degeneration ◽

Pontine Hemorrhage

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

Child s Nervous System ◽

10.1007/s00381-020-05020-8 ◽

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.

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Progressive multifocal leukoencephalopathy with bilateral middle cerebellar peduncle lesions confirmed by repeated CSF-JC virus tests and coexistence of JC virus granule cell neuronopathy. Report of a case

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-000873 ◽

2016 ◽

Vol 56 (7) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

Daisuke Ito ◽

Keizo Yasui ◽

Yasuhiro Hasegawa ◽

Kazuo Nakamichi ◽

Masahisa Katsuno ◽

...

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Granule Cell ◽

Jc Virus ◽

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle ◽

Granule Cell Neuronopathy

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Cerebellar peduncle myelinolysis: case report

Neuroradiology ◽

10.1007/s00234-002-0845-4 ◽

2002 ◽

Vol 44 (9) ◽

pp. 768-769 ◽

Cited By ~ 4

Author(s):

K. Mangat ◽

K. Sherlala

Keyword(s):

Case Report ◽

Cerebellar Peduncle

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Isolated Bilateral Middle Cerebellar Peduncle Infarcts

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.03.035 ◽

2013 ◽

Vol 22 (8) ◽

pp. e645-e646 ◽

Cited By ~ 5

Author(s):

Seby John ◽

Mohamed Hegazy ◽

Esteban Cheng Ching ◽

Irene Katzan

Keyword(s):

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle

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

Journal of Neurosurgery ◽

10.3171/2020.12.jns203608 ◽

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.

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