脳幹部橋海綿状血管腫に対する経錐体到達法の有用性

Abstract

Surgical resection of pontine cavernomas remains a particularly formidable challenge in the neurosurgical field because of their deep-seated and eloquent locations. We report and discuss our experience and surgical approaches in the treatment of pontine cavernomas via a transpetrosal approach. We investigated eight cases of pontine cavernomas who underwent resection via an anterior or combined transpetrosal approach at our hospital between 2008 and 2015. These eight patients comprised six men and two women with a mean age of 46.9 years. All cases presented with neurological deficits caused by hemorrhage before surgery. We used an anterior transpetrosal approach in six cases and a combined transpetrosal approach in two. Gross total resection of the tumor was achieved in all cases. No postoperative complications, viz., worsening of facial nerve palsy, ocular movement disorder, or hemiplegia were noted in any patient. It is possible to obtain a wide surgical corridor from the ventral and lateral side via an anterior or combined tranpetrosal approach for treatment of pontine cavernomas. A small cortical incision with multi-directional dissection is the best approach to avoid additional neurological deficits. We conclude that resection of pontine cavernomas via a transpetrosal approach might be superior to other approaches to minimize postoperative neurological deficits.