“…The lateral supracerebellar infratentorial approach (Fig. 11 ) is most useful to reach the posterolateral aspect of the midbrain [ 2 , 6 , 9 , 13 , 19 , 24 ] and offers a straight-line viewing trajectory to the lateral mesencephalic sulcus that is regarded as one of the safe entry zones into the midbrain. In rare cases, a midbrain MCM can even be exposed through the fourth ventricle using a telovelar exposure of the rhomboid fossa and a transaqueductal access route [ 5 , 8 , 20 ].…”
Section: Discussionmentioning
confidence: 99%
“…12 ). This approach is facilitated by extending the craniotomy superiorly beyond the level of the transverse sinus and necessitates the preservation of supracerebellar bridging veins [ 2 ]. Fig.…”
Section: Discussionmentioning
confidence: 99%
“…The lateral supracerebellar infratentorial approach (Fig. 11) is most useful to reach the posterolateral aspect of the midbrain [2,6,9,13,19,24] and offers a straight-line viewing trajectory to the lateral mesencephalic sulcus that is regarded as one of the safe entry zones into the midbrain. In rare cases, a midbrain MCM Fig.…”
Section: Surgical Access and Entry Points Into The Midbrainmentioning
Background
The purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome.
Methods
The authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery.
Results
Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up.
Conclusion
This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.
“…The lateral supracerebellar infratentorial approach (Fig. 11 ) is most useful to reach the posterolateral aspect of the midbrain [ 2 , 6 , 9 , 13 , 19 , 24 ] and offers a straight-line viewing trajectory to the lateral mesencephalic sulcus that is regarded as one of the safe entry zones into the midbrain. In rare cases, a midbrain MCM can even be exposed through the fourth ventricle using a telovelar exposure of the rhomboid fossa and a transaqueductal access route [ 5 , 8 , 20 ].…”
Section: Discussionmentioning
confidence: 99%
“…12 ). This approach is facilitated by extending the craniotomy superiorly beyond the level of the transverse sinus and necessitates the preservation of supracerebellar bridging veins [ 2 ]. Fig.…”
Section: Discussionmentioning
confidence: 99%
“…The lateral supracerebellar infratentorial approach (Fig. 11) is most useful to reach the posterolateral aspect of the midbrain [2,6,9,13,19,24] and offers a straight-line viewing trajectory to the lateral mesencephalic sulcus that is regarded as one of the safe entry zones into the midbrain. In rare cases, a midbrain MCM Fig.…”
Section: Surgical Access and Entry Points Into The Midbrainmentioning
Background
The purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome.
Methods
The authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery.
Results
Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up.
Conclusion
This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.
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