How I do it: parietal trans-sulcal para-fascicular approach to lateral thalamic/internal capsule cavernous malformation

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Abstract

Background

The surgical management of deep brain lesions is challenging, with significant morbidity. Advances in surgical technology have presented the opportunity to tackle these lesions.

Methods

We performed a complete resection of a thalamic/internal capsule CM using a tubular retractor system via a parietal trans-sulcal para-fascicular (PTPF) approach without collateral injury to the nearby white matter tracts.

Conclusion

PTPF approach to lateral thalamic/internal capsule lesions can be safely performed without injury to eloquent white matter fibres. The paucity of major vessels along this trajectory and the preservation of lateral ventricle integrity make this approach a feasible alternative to traditional approaches.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00701-021-04884-2.

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Most cited references 7

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Hemorrhage from cerebral cavernous malformations: a systematic pooled analysis.

Bradley Gross, Rose Du (2017)

OBJECTIVE The aim of this paper is to define an overall cavernous malformation (CM) hemorrhage rate and risk factors for hemorrhage. METHODS The authors performed a systematic, pooled analysis via the PubMed database through October 2015 using the terms "cavernoma," "cavernous malformation," "natural history," "bleeding," and "hemorrhage." English-language studies providing annual rates and/or risk factors for CM hemorrhage were included. Data extraction, performed independently by the authors, included demographic data, hemorrhage rates, and hemorrhage risk factors. RESULTS Across 12 natural history studies with 1610 patients, the mean age at presentation was 42.7 years old and 52% of patients (95% CI 49%-55%) were female. Presentation modality was seizure in 30% (95% CI 25%-35%), hemorrhage in 26% (95% CI 17%-37%), incidental in 17% (95% CI 9%-31%), and focal deficits only in 16% of cases (95% CI 11%-23%). CM location was lobar in 66% (95% CI 61%-70%), brainstem in 18% (95% CI 13%-24%), deep supratentorial in 8% (95% CI 6%-10%), and cerebellar in 8% (95% CI 5%-11%). Pooling 7 studies that did not assume CM presence since birth, the annual hemorrhage rate was 2.5% per patient-year over 5081.2 patient-years of follow-up (95% CI 1.3%-5.1%). Pooling hazard ratios across 5 studies that evaluated hemorrhage risk factors, prior CM hemorrhage was a significant risk factor for hemorrhage (HR 3.73, 95% CI 1.26-11.1; p = 0.02) while younger age, female sex, deep location, size, multiplicity, and associated developmental venous anomalies (DVAs) were not. CONCLUSIONS Although limited by the heterogeneity of incorporated reports and selection bias, this study found prior hemorrhage to be a significant risk factor for CM bleeding, while age, sex, CM location, size, multiplicity, and associated DVAs were not. Future natural history studies should compound annual hemorrhage rate with prospective seizure and nonhemorrhagic neurological deficit rates.

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Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage.

R Willinsky, Andrew P. Porter, Gary W Harper … (1997)

Despite recent studies of the natural history of cavernous malformations, there remains significant uncertainty concerning hemorrhage rates and the importance of lesion location. Controversy arises over varying definitions of "hemorrhage." What is ultimately important to the patient is the occurrence of a neurological event, which may or may not be associated with radiologically documented hemorrhage, as well as the chance of recovery after such an event. The purpose of this study was to determine the rates of occurrence and sequelae of neurological events in 173 patients referred to our vascular malformation clinic with cavernous malformations. All patient data were entered into a database. The mean age at presentation for the 173 patients was 37.5 years. The lesion location was deep (brainstem, cerebellar nuclei, thalamus, or basal ganglia) in 64 patients (37%) and superficial in 109 (63%). Thirty-one patients (18%) had multiple lesions. Disease presentation was due to seizures in 62 patients (36%), hemorrhage in 44 (25%), focal neurological deficit without documented hemorrhage in 35 (20%), headache alone in 11 (6%), and incidental findings in 21 patients (12%). The results obtained in the 110 patients eligible for follow-up review were used to derive information on the rates of hemorrhage and neurological events. An interval event (neurological deterioration) required both symptoms and signs. The total mean follow-up period was 46 months, the majority (65%) of which was prospective. There were 18 interval events in 427 patient-years of follow-up review, for an overall annual event rate of 4.2%. Location was the most important factor for predicting interval event occurrence, with significantly higher rates for deeply located (10.6%/year) compared with superficially located lesions (0%/year) (p = 0.0001). Of patients suffering a neurological event, only 37% had complete resolution of their deficits. This largely prospective study indicates that deep cavernous malformations carry a worse prognosis than superficial lesions with respect to annual rates of neurological deterioration. The alarming rate of adverse clinical events occurring in patients with deep lesions is punctuated by the fact that less than one-half of them recover fully during long-term follow-up review.

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Cranial Cavernous Malformations

Christopher Stapleton, Fred G Barker (2018)

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Author and article information

Contributors

Michael Amoo:

ORCID: http://orcid.org/0000-0001-6886-6714

michaelamoo@rcsi.ie

Journal

Journal ID (nlm-ta): Acta Neurochir (Wien)

Journal ID (iso-abbrev): Acta Neurochir (Wien)

Title: Acta Neurochirurgica

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0001-6268

ISSN (Electronic): 0942-0940

Publication date (Electronic): 24 June 2021

Publication date PMC-release: 24 June 2021

Publication date (Print): 2021

Volume: 163

Issue: 9

Pages: 2497-2501

Affiliations

[1 ]Department of Neurosurgery, Beacon Hospital, Sandyford, Dublin 18, Ireland

[2 ]GRID grid.414315.6, ISNI 0000 0004 0617 6058, National Neurosurgical Centre, , Beaumont Hospital, ; Dublin 9, Ireland

[3 ]GRID grid.4912.e, ISNI 0000 0004 0488 7120, Royal College of Surgeons in Ireland, ; Dublin, Ireland

[4 ]GRID grid.414315.6, ISNI 0000 0004 0617 6058, Department of Neurology and Clinical Neurophysiology, , Beaumont Hospital, ; Dublin 9, Ireland

[5 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Department of Academic Neurology, , Trinity College Dublin, ; Dublin, Ireland

Author information

Michael Amoo http://orcid.org/0000-0001-6886-6714

Mohsen Javadpour http://orcid.org/0000-0001-9836-1741

Article

Publisher ID: 4884

DOI: 10.1007/s00701-021-04884-2

PMC ID: 8357681

PubMed ID: 34164736

SO-VID: d7e32759-3bde-4d1a-9462-4caa43492575

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 2 March 2021

Date accepted : 13 May 2021

Funding

Funded by: Royal College of Surgeons in Ireland (RCSI)

Open Access :

Open Access funding provided by the IReL Consortium

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: thalamus,internal capsule,brainpath®,tubular retractor,para-fascicular surgery,cavernous malformation,minimally invasive neurosurgery,exoscope,orbeye®

Data availability:

ScienceOpen disciplines: Surgery

Keywords: thalamus, internal capsule, brainpath®, tubular retractor, para-fascicular surgery, cavernous malformation, minimally invasive neurosurgery, exoscope, orbeye®

How I do it: parietal trans-sulcal para-fascicular approach to lateral thalamic/internal capsule cavernous malformation

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Abstract

Background

Methods

Conclusion

Supplementary Information

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Karger: Oncology

Most cited references 7

Hemorrhage from cerebral cavernous malformations: a systematic pooled analysis.

Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage.

Cranial Cavernous Malformations

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