TY - JOUR
T1 - Endoscopic endonasal approach for brainstem cavernous malformation
AU - Goldschmidt, Ezequiel
AU - Venteicher, Andrew S.
AU - Nuñez, Maximiliano
AU - Wang, Eric
AU - Snyderman, Carl
AU - Gardner, Paul
N1 - Publisher Copyright:
© 2019, Ezequiel Goldschmidt, Andrew S. Venteicher, Maximiliano Nuñez, Eric Wang, Carl Snyderman, and Paul Gardner.
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
KW - brainstem
KW - cavernous malformation
KW - endonasal endoscopic approach
KW - video
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U2 - 10.3171/2019.10.FocusVid.19399
DO - 10.3171/2019.10.FocusVid.19399
M3 - Article
AN - SCOPUS:85137667327
SN - 2643-5217
VL - 1
JO - Neurosurgical Focus: Video
JF - Neurosurgical Focus: Video
IS - 2
M1 - V2
ER -