Resection of anterolateral midbrain cavernous malformation via orbitozygomatic transsylvian pretemporal approach with uncal resection.

Krishna C Joshi,Hamid Borghei-Razavi,Varun R Kshettry

doi:10.3171/2019.7.focusvid.19153

Abstract

Brainstem cavernomas are benign, angiographically occult, low-flow lesions and constitute 18%–35% of intracranial cavernomas.4,6 They are known to have an annual rupture risk of 2%–6%,2,5 and once symptomatic, they frequently cause progressive neurological morbidity. A 22-year-old lady presented with progressive profound neurologic deficits from three distinct hemorrhages over 2 months. Surgery was indicated given the aggressive natural history, and the lesion now presented to the surface with displacement of corticospinal tracts noted on diffusion tensor imaging.1,7 We describe a surgical technique via an orbitozygomatic transsylvian pretemporal approach with uncal resection to open the oculomotor-tentorial window and resect the lesion.3The video can be found here: https://youtu.be/j5yYp4OsaRc.

Highlights

Brainstem cavernomas are benign, angiographically occult, low-flow lesions and constitute 18%–35% of intracranial cavernomas.[4,6] They are known to have an annual rupture risk of 2%–6%,2,5 and once symptomatic, they frequently cause progressive neurological morbidity
We will be reviewing a case of an anterolateral midbrain cavernous malformation resected via an orbitozygomatic transsylvian pretemporal approach with uncal resection
CT and subsequent MRI demonstrated a hemorrhagic lesion in the right cerebral peduncle most consistent with a cavernous malformation

Summary

Introduction

Angiographically occult, low-flow lesions and constitute 18%–35% of intracranial cavernomas.[4,6] They are known to have an annual rupture risk of 2%–6%,2,5 and once symptomatic, they frequently cause progressive neurological morbidity. CT and subsequent MRI demonstrated a hemorrhagic lesion in the right cerebral peduncle most consistent with a cavernous malformation. The lesion did not appear to come to the pial surface first, and considering the deficits were mild and this was her first presentation, we elected for observation. Ten days later she represented with double vision, new mild right cranial nerve palsy, worsening in her left-sided hemiparesis, and sensory abnormalities.

Results

Conclusion