Stefan Linsler1, Joachim Oertel2. 1. Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany. Electronic address: stefan.linsler@uks.eu. 2. Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany.
Abstract
OBJECTIVE: To report a technique of endoscopic transclival resection of a hemorrhagic brainstem cavernous malformation manifesting in the ventral pons. METHODS: A 29-year-old woman presented with numbness and tingling of the right arm and leg and loss of fine motor control. Magnetic resonance imaging revealed a cavernoma in the ventromedial brainstem on the ventral surface. A purely endoscopic, endonasal, transclival approach was used to resect this cavernoma. Computed tomography/magnetic resonance imaging merged navigation (StealthStation, Medtronic) was used. RESULTS: The patient had no neurologic deficits postoperatively. The motor control loss and tingling disappeared. She did not experience any complications. Cerebrospinal fluid leakage appeared to result from using the very small opening of the skull base and dura mater and was the reason for the use of a lumbar drain for several days. At the 6-week follow-up examination, the patient was in excellent condition with no neurologic deficits and had returned to her full-time job. CONCLUSIONS: Successful endoscopic, endonasal, transclival resection of a brainstem cavernous malformation was described. This patient experienced improvement in neurologic symptoms after surgery without morbidity. Technologic advances in endoscopic skull base approaches provide access to lesions of the brainstem that previously required more invasive approaches. The endonasal transclival approach provides the most direct route to ventral pontine lesions. Early intervention in brainstem cavernous malformation is indicated and should be performed with an individualized approach taking into consideration the possible complications.
OBJECTIVE: To report a technique of endoscopic transclival resection of a hemorrhagic brainstem cavernous malformation manifesting in the ventral pons. METHODS: A 29-year-old woman presented with numbness and tingling of the right arm and leg and loss of fine motor control. Magnetic resonance imaging revealed a cavernoma in the ventromedial brainstem on the ventral surface. A purely endoscopic, endonasal, transclival approach was used to resect this cavernoma. Computed tomography/magnetic resonance imaging merged navigation (StealthStation, Medtronic) was used. RESULTS: The patient had no neurologic deficits postoperatively. The motor control loss and tingling disappeared. She did not experience any complications. Cerebrospinal fluid leakage appeared to result from using the very small opening of the skull base and dura mater and was the reason for the use of a lumbar drain for several days. At the 6-week follow-up examination, the patient was in excellent condition with no neurologic deficits and had returned to her full-time job. CONCLUSIONS: Successful endoscopic, endonasal, transclival resection of a brainstem cavernous malformation was described. This patient experienced improvement in neurologic symptoms after surgery without morbidity. Technologic advances in endoscopic skull base approaches provide access to lesions of the brainstem that previously required more invasive approaches. The endonasal transclival approach provides the most direct route to ventral pontine lesions. Early intervention in brainstem cavernous malformation is indicated and should be performed with an individualized approach taking into consideration the possible complications.
Authors: Francesco Belotti; Francesco Tengattini; Davide Mattavelli; Marco Ferrari; Antonio Fiorentino; Silvia Agnelli; Alberto Schreiber; Piero Nicolai; Marco Maria Fontanella; Francesco Doglietto Journal: Neurosurg Rev Date: 2020-02-14 Impact factor: 3.042
Authors: Walid I Essayed; Prashin Unadkat; Ahmed Hosny; Sarah Frisken; Marcio S Rassi; Srinivasan Mukundan; James C Weaver; Ossama Al-Mefty; Alexandra J Golby; Ian F Dunn Journal: J Neurosurg Date: 2018-03-02 Impact factor: 5.115