Abstract
Brainstem cavernous malformations are especially difficult to treat because of their deep location and intimate relation with eloquent structures. This is the case of a 26-year-old female presenting with dizziness, dysmetria, nystagmus and unbalance. Imaging depicted a lesion highly suggestive of a cavernous malformation in the left inferior cerebellar peduncle. Following a suboccipital midline craniotomy, the cerebellomedullary fissure was dissected and the lesion was identified bulging the surface. The malformation was completely removed with constant intraoperative neurophysiological monitoring. The patient presented improvement of initial symptoms with no new deficits. Surgical resection of brainstem cavernous malformations can be successfully performed, especially when superficial, using the inferior cerebellar peduncle as an entry zone.The video can be found here: https://youtu.be/-GGZe_CaZnQ.
Highlights
This is a 3-dimensional operative video of the microsurgical resection of an inferior cerebellar peduncle cavernous malformation
0:36 Preoperative imaging Preoperative MRI demonstrated a mass in the left inferior cerebellar peduncle, with mixed signal in T1 and T2 enhancing heterogeneously after contrast administration and with blooming artifact in T2 star weighted image, suggestive of a cavernous malformation. (Batra et al, 2009) Here we see the location of the lesion in the inferior cerebellar peduncle and a bulging area in the floor of the fourth ventricle
1:05 3D models In this 3D model we can better understand the positioning of the lesion to be approached
Summary
This is a 3-dimensional operative video of the microsurgical resection of an inferior cerebellar peduncle cavernous malformation. 0:36 Preoperative imaging Preoperative MRI demonstrated a mass in the left inferior cerebellar peduncle, with mixed signal in T1 and T2 enhancing heterogeneously after contrast administration and with blooming artifact in T2 star weighted image, suggestive of a cavernous malformation. (Batra et al, 2009) Here we see the location of the lesion in the inferior cerebellar peduncle and a bulging area in the floor of the fourth ventricle. 1:05 3D models In this 3D model we can better understand the positioning of the lesion to be approached.
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