Abstract
We present an effective and easily applied technique for cisterna magna reconstruction with arachnoid suturing in brainstem surgery. Suturing with 10-0 monofilament was done in a patient with a medulla oblongata hemangioblastoma (diagnosed von Hippel-Lindau disease). Seven years later, follow-up imaging revealed a new lesion close to the previous one and the patient underwent reoperation. The craniotomy and dural incision were repeated, and the intact arachnoid was visualized with no meningocerebral adhesions. This technique preserves normal anatomic landmarks and facilitates and shortens dissection in reoperations, almost like a virgin case. We propose this technique for every lower brainstem and fourth ventricle procedure.The video can be found here: https://youtu.be/RKMcSoK6ycY.
Highlights
The art of microneurosurgery relies on atraumatic exploration, total removal of a lesion without harming normal structures, and, as much as possible, reconstruction of the normal anatomy
We demonstrate cisterna magna reconstruction with arachnoid suturing for state-of-the-art brainstem surgery (Spetzler et al, 2019)
The MRI findings revealed a hemangioblastoma of the medulla oblongata
Summary
The art of microneurosurgery relies on atraumatic exploration, total removal of a lesion without harming normal structures, and, as much as possible, reconstruction of the normal anatomy. KEYWORDS arachnoid suturing; brainstem surgery; brainstem hemangioblastoma; cisterna magna reconstruction; meningocerebral adhesion; posterior fossa reconstruction; video We demonstrate cisterna magna reconstruction with arachnoid suturing for state-of-the-art brainstem surgery (Spetzler et al, 2019). The patient’s preoperative MRI (magnetic resonance imaging) revealed a solid lesion on the left posterior medulla oblongata with a macrocystic component. Major feeding arteries and draining veins were determined.
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