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      Supracerebellar transtentorial resection of a ruptured thalamomesencephalic cavernous malformation

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          Abstract

          Thalamomesencephalic cavernous malformations are located high in the brainstem and may be difficult to reach. We present a case of such a lesion which was successfully approached via the supracerebellar transtentorial route. Our enclosed video provides elements to justify this posterior approach and illustrates the steps required for the cavernoma’s safe removal, which include opening of the tentorium and gentle retraction of the exposed temporal lobe.

          The video can be found here: https://youtu.be/Ex5OfLyBzPY.

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          Surgical approaches to brainstem cavernous malformations.

          Adib A. Abla, Jay Turner, Alim P. Mitha … (2010)
          Brainstem cavernous malformations (CMs) are low-flow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages that appear to occur more frequently than hemorrhage from supratentorial cavernomas. Brainstem CMs can be removed using 1 of the 5 standard skull-base approaches: retrosigmoid, suboccipital (with or without telovelar approach), supracerebellar infratentorial, orbitozygomatic, and far lateral. Patients being referred to a tertiary institution often have lesions that are aggressive with respect to bleeding rates. Nonetheless, the indications for surgery, in the authors' opinion, are the same for all lesions: those that are symptomatic, those that cause mass effect, or those that abut a pial surface. Patients often have relapsing and remitting courses of symptoms, with each hemorrhage causing a progressive and stepwise decline. Many patients experience new postoperative deficits, most of which are transient and resolve fully. Despite the risks associated with operating in this highly eloquent tissue, most patients have had favorable outcomes in the authors' experience. Surgical treatment of brainstem CMs protects patients from the potentially devastating effects of rehemorrhage, and the authors believe that the benefits of intervention outweigh the risks in patients with the appropriate indications.
          Article 0 comments Cited 28 times – based on 0 reviews     Review now
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            Brainstem cavernous malformations: anatomical, clinical, and surgical considerations.

            Giuliano Giliberto, David Factor, Kelly Flemming … (2010)
            Symptomatic brainstem cavernous malformations carry a high risk of permanent neurological deficit related to recurrent hemorrhage, which justifies aggressive management. Detailed knowledge of the microscopic and surface anatomy is important for understanding the clinical presentation, predicting possible surgical complications, and formulating an adequate surgical plan. In this article the authors review and illustrate the surgical and microscopic anatomy of the brainstem, provide anatomoclinical correlations, and illustrate a few clinical cases of cavernous malformations in the most common brainstem areas.
            Article 0 comments Cited 27 times – based on 0 reviews     Review now
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              Brainstem Cavernous Malformations

              Roxanna M Garcia, Michael E. Ivan, Michael Lawton (2015)
              Once considered inoperable lesions in inviolable territory, brainstem cavernous malformations (BSCM) are now surgically curable with acceptable operative morbidity. Recommending surgery is a difficult decision that would be facilitated by a grading system designed specifically for BSCMs that predicted surgical outcomes.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurosurg Focus Video
                Journal ID (iso-abbrev): Neurosurg Focus Video
                Journal ID (publisher-id): Neurosurg Focus Video
                Title: Neurosurgical Focus: Video
                Publisher: American Association of Neurological Surgeons
                ISSN (Electronic): 2643-5217
                Publication date Collection: July 2019
                Publication date (Electronic): 1 July 2019
                Volume: 1
                Issue: 1 , Resection of Cavernous Malformation
                Electronic Location Identifier: V10
                Affiliations
                [1]Division of Neurosurgery, Department of Surgery, Centre Hospitalier de L’Université de Montreal, Quebec, Canada
                Author notes
                Correspondence Michel W. Bojanowski, Centre Hospitalier de L’Université de Montreal, Montreal, Quebec, Canada. michel.bojanowski.chum@ 123456ssss.gouv.qc.ca .

                INCLUDE WHEN CITING Published online July 1, 2019; DOI: http://thejns.org/doi/abs/10.3171/2019.7.FocusVid.19164

                Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.

                Article
                Publisher ID: 2019.7.FocusVid.19164
                DOI: 10.3171/2019.7.FocusVid.19164
                PMC ID: 9541724
                PubMed ID: 36285063
                SO-VID: 66dd9841-cf37-4637-a802-da69879c6bfa
                Copyright © © 2019, Michel W. Bojanowski, Moujahed Labidi, Nathalie L’Ecuyer, Chiraz Chaalala
                License:

                This is an open access article distributed under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 28 February 2019
                Date accepted : 08 May 2019
                Page count
                Figures: 0, Tables: 0, References: 5, Pages: 0
                Categories
                Subject: Article

                Keywords: cavernous malformation,resection,thalamus,brainstem,supracerebellar transtentorial,video
                Data availability:
                Keywords: cavernous malformation, resection, thalamus, brainstem, supracerebellar transtentorial, video

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