Microsurgical resection of a large cavernous malformation of the medulla oblongata.

Sima Sayyahmelli,Mustafa K Başkaya

doi:10.3171/2019.7.focusvid.1998

Abstract

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

Highlights

In this video we demonstrate important steps in the microsurgical resection of a large, challenging cavernous malformation in the medulla oblongata
Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection
Upon opening the thick arachnoid, a large vascular malformation with the typical appearance of cavernous malformation came to view at the lower aspect of the medulla oblongata (1:35)

Summary

Introduction

In this video we demonstrate important steps in the microsurgical resection of a large, challenging cavernous malformation in the medulla oblongata. MRI showed a heterogeneous enhancing intra-axial mass lesion located within the posterior medulla at the level of the foramen magnum (0:34). Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy (0:43) for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.

Results

Conclusion