Microsurgical resection of an enlarging lateral pontomedullary cavernous malformation.

Salomon Cohen-Cohen,Leonardo Rangel-Castilla,Giuseppe Lanzino

doi:10.3171/2019.7.focusvid.1978

Abstract

The extended retrosigmoid approach provides an excellent corridor to the lateral aspect of the pontomedullary junction (PMJ).1,2 This video demonstrates a microsurgical resection of a progressive enlarging cavernous malformation (CM) of the PMJ. The patient is a 33-year-old woman with progressive symptoms, including right facial droop, left hemianesthesia, diplopia, and nystagmus. The patient underwent a right extended retrosigmoid approach with intraoperative neuronavigation and neuromonitoring. Lower cranial nerve dissection allowed access to the lateral PMJ. A longitudinal corticotomy was performed above the glossopharyngeal. The CM was removed in a piecemeal fashion. Postoperative MRI confirmed gross-total resection and the patient remained neurologically stable.The video can be found here: https://youtu.be/K_TtiTo1RsQ.

Highlights

In this video we present a microsurgical resection of an enlarging lateral pontomedullary cavernous malformation
An MRI 1 year later demonstrated some enlargement of the cavernous malformation, and some of the symptoms worsened and some new symptoms appear like including facial numbness and mild imbalance
We selected a lateral approach with an extended retrosigmoid craniotomy

Summary

Introduction

In this video we present a microsurgical resection of an enlarging lateral pontomedullary cavernous malformation. The patient is a 32-year-old female presenting with 1-month history of intermittent left arm numbness and tingling. On initial MRI we observed a small cavernous malformation on the right side of the pontomedullary junction. We decided to manage it conservatively and follow up with MRI.

Results

Conclusion