Endoscopic endonasal approach for brainstem cavernous malformation

Ezequiel Goldschmidt, Andrew S. Venteicher, Maximiliano Nuñez, Eric Wang, Carl Snyderman, Paul Gardner

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

This 25-year-old woman presented after a second hemorrhage from a mesencephalic cavernous malformation. High-definition fiber tracking demonstrated lateral displacement of the corticospinal tracts, making a midline approach ideal. The lesion appeared to present to the third ventricle, but a transcallosal approach was abandoned due to the posterior third ventricular location and after FIESTA imaging revealed a superior and medial rim of normal parenchyma that would have to be transgressed to access the malformation. An endoscopic endonasal approach with interdural pituitary hemi-transposition was performed. The interpeduncular cistern was accessed and the thalamoperforating arteries dissected to access the cavernous malformation that was completely removed in a piecemeal fashion. The patient’s preexisting internuclear ocular palsies and hemiparesis were slightly worsened after surgery as predicted by a drop in anterior tibi-alis motor evoked potentials. Postoperative MRI showed no infarct, and the hemiparesis was back to baseline at 1-month follow-up.

Original languageEnglish (US)
Article numberV2
JournalNeurosurgical Focus: Video
Volume1
Issue number2
DOIs
StatePublished - Oct 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019, Ezequiel Goldschmidt, Andrew S. Venteicher, Maximiliano Nuñez, Eric Wang, Carl Snyderman, and Paul Gardner.

Keywords

  • brainstem
  • cavernous malformation
  • endonasal endoscopic approach
  • video

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