Posterior petrosectomy for resection of pontine cavernous malformation.

Avital Perry,Colin L Driscoll,Michael J Link,Thomas J Sorenson,Christopher S Graffeo

doi:10.3171/2019.10.focusvid.19389

Abstract

Cavernous malformations (CMs) are low-pressure, focal, vascular lesions that may occur within the brainstem and require treatment, which can be a substantial challenge. Herein, we demonstrate the surgical resection of a hemorrhaged brainstem CM through a posterior petrosectomy approach. After dissection of the overlying vascular and meningeal structures, a safe entry zone into the brainstem is identified based on local anatomy and intraoperative neuronavigation. Small ultrasound probes can also be useful for obtaining real-time intraoperative feedback. The CM is internally debulked and resected in a piecemeal fashion through an opening smaller than the CM itself. As brainstem CMs are challenging lesions, knowledge of several surgical nuances and adoption of careful microsurgical techniques are requisite for success.The video can be found here: https://youtu.be/szB6YpzkuCo.

Highlights

This case demonstrates a posterior petrosal approach for a large brainstem cavernous malformation (0:27)
CN VIII can be seen in the center of the exposure and the arachnoid above this widely opened
The superior petrosal vein and sinus is doubly ligated with clips and the tentorium is incised all the way to the tentorial incisura, taking great care not to damage CN IV

Summary

Introduction

KEYWORDS hemorrhage; cavernous malformation; brainstem; posterior petrosectomy; microsurgery; video This case demonstrates a posterior petrosal approach for a large brainstem cavernous malformation (0:27). The patient is a 20-year-old young man with pertinent history of a left temporal fibrillary astrocytoma treated 8 years prior to presentation. A left temporal occipital craniotomy and retrolabrynthine presigmoid exposure was performed.

Results

Conclusion