Endoscopic Endonasal Transclival Resection of a Brainstem Cavernoma: A Detailed Account of Our Technique and Comparison with the Literature

Linsler, Stefan; Oertel, Joachim

doi:10.1016/j.wneu.2015.08.029

Cited by 50 publications

(26 citation statements)

References 27 publications

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“…The boxplot, and the significant improvement of reconstructive techniques have significantly extended the endoscopic option beyond the limits of the extradural compartments. In fact, the use of the EEEAs has recently been proposed for intradural lesions, such as meningiomas involving the ventral FM and the petroclival region (4,19,23,53), and ventrally located ponto-medullary cavernomas (12,18,27,36,44,51), or even aneurysms of the vertebrobasilar system (14,26,45,48,49). Due to the lower rate of infection or functional complications with the use of EEEAs, such approaches are more preferred than purely microscopic or endoscope-assisted transoral approaches (7).…”

Section: Dimensional Variability Of the Condylar And Basilar Partmentioning

confidence: 99%

Morphometric and radiomorphometric study of the correlation between the foramen magnum region and the anterior and posterolateral approaches to ventral intradural lesions

Luzzi

Maestro

Elia

et al. 2019

Turkish Neurosurgery

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AIM: To identify the range of dimensional morphometric variability correlated to the basilar and condylar part of the occipital bone, which may affect the choice of approach to ventral intradural foramen magnum (FM) lesions. MATERIAL and METHODS: In total, 25 dry skulls and 50 head computed tomography (CT) scan results have been assessed in detail, focusing on the FM, occipital condyles, jugular tubercles (JT), and hypoglossal canals (HC). A morphometric analysis has been carried out using linear and angular measurements to estimate the range of the dimensional variability of these structures. Data were presented as mean ± standard deviation, ranges, and interquartile range on a boxplot. The sagittal intercondylar angle (SICA) and anterior condylar angle (ACA) have been found to be important in estimating the axial orientation of the condyles, whereas the JT-HC interline ratio has indicated the prominence of the tubercles. RESULTS: The SICA and ACA have exhibited high variability. The average JT-HC interline ratio was 0.8. Wider SICA-ACA and higher JT-HC interline ratio make the posterolateral approach advantageous. An anterior medial or far-medial endoscopic route is indicated in opposite conditions. In this study, two illustrative cases have been reported. CONCLUSION: A cautious preoperative morphometric evaluation of the FM region must be considered prior to using tailored and safe anterior endoscopic and posterolateral approaches to ventral intradural lesions to identify the advantages of a certain corridor as much as possible, thereby minimizing the risk of complications.

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Section: Dimensional Variability Of the Condylar And Basilar Partmentioning

confidence: 99%

Morphometric and radiomorphometric study of the correlation between the foramen magnum region and the anterior and posterolateral approaches to ventral intradural lesions

Luzzi

Maestro

Elia

et al. 2019

Turkish Neurosurgery

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“…This regular approach is used more often by neurosurgeons than more bulky, complex, or exceptional approaches to the skull base. [8][9][10][11][12][13] The presigmoid approach has been proposed as an alternative to allow a flatter approach to the most anterior lesions in the brainstem, thus avoiding the retraction of the pons. In our opinion, this approach is more limited and increases the risk of postoperative CSF fistula and infection.…”

Section: Discussionmentioning

confidence: 99%

Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions

González-Darder

Capilla-Guasch

Real-Peña

2019

J Neurol Surg B Skull Base

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Objectives The main objective of this article is to describe a simple and safe protocol for the microsurgical management of ventrally located intrinsic pontomedullary lesions based on the retrosigmoid approach, cortectomy performed utilizing safe entry zones of the pons and medulla, and a delicate microsurgical resection. The intraoperative protocol includes redundant procedures that provide security in decision-making during surgery. Design A prospective series of 11 cases is presented. All patients were studied following the same clinical and imaging workup. A regular retrosigmoid craniotomy surgical approach was utilized. The peritrigeminal area in the pons and the olivary area in the medulla were considered as the safe entry zones. Neuronavigation of the white fiber tracts and electrophysiological monitoring were used as intraoperative aids to locate the lesions, the safe entry zones, and the placement of the cortectomy. Results Six lesions were pontine, two medullary, and the remaining six pontomedullary. Eight lesions were cavernomas, while the remaining three tumors. Overall, we obtained a postoperative functional improvement in the affected cranial nerves in 90.1% of the patients and a total or partial recovery of long ascending or descending pathway symptoms in 72.3% of the patients. All the patients were satisfied with the procedure and the results. Conclusions Radical resection of ventral intrinsic pontomedullary lesions displays a high degree of intraoperative reliability, and a good clinical result is possible using simple surgical procedures. The anatomical references are the first element in the decision-making process during surgery.

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“…[1][2][3][4] Brainstem cavernomas are rare (18%) and present a bleeding rate higher than supratentorial cavernomas; they are more common in the pons (61%), with an estimated bleeding rate of 2-6.6% per year. 1,[5][6][7][8] In the pediatric population, the lesion is found in the pons (rate of 73%), and it presents a 12.3% rate of bleeding per year and a 32.5% rate of rebleeding per year.…”

Section: Introductionmentioning

confidence: 99%

“…The complication of this approach is the risk of cerebrospinal fluid leak, even though it can be minimized with lumbar drainage and small bone defects. 1,3 The endoscopy requires a great surgical ability and adequate tools; the surgeon must be trained and the equipment must be available. Kassan et al 24 classified the complexity of endoscopic lesions from I to V; anterior pontine cavernomas have a classification V.…”

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confidence: 99%

Anterior pontine cavernoma: what should be done?

Neves¹,

Aguiar²,

Belsuzarri³

et al. 2017

ATROA

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Introduction: Anterior pontine cavernomais a rare pathology with difficult access; it predominantly occurs in middle-aged patients with a high risk of bleeding and rebleeding. There is a direct association with genetic inheritance due to the CCM1, CCM2 and CCM3 genes, and if it is associated, there is a higher risk of severity. Materials and methods:Analysis of PUBMED publications about ventral pontine cavernomas, anterolateral pontine cavernomas, and main surgical approaches.Results and discussion: Pontine cavernomas have a bleeding risk of 5% per year and rebleeding of 30% per year; therefore, it is a surgical pathology in which most authors approach from four to six weeks after bleeding for total resection and curative purposes. There are different approaches and they depend on the topography of the lesion and the surgeon`s ability; technologies such as monitoring, neuronavigation, and tractography must be used to reduce the risk of lesions. The most used approaches are retrosigmoid, presigmoid, and anterior transpetrosal; the use of endoscopic approaches has been increasing recently. Conclusion:Anterior pontine cavernoma is a severe pathology that must be surgically treated to decrease the risk of bleeding and rebleeding.

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Endoscopic Endonasal Transclival Resection of a Brainstem Cavernoma: A Detailed Account of Our Technique and Comparison with the Literature

Cited by 50 publications

References 27 publications

Morphometric and radiomorphometric study of the correlation between the foramen magnum region and the anterior and posterolateral approaches to ventral intradural lesions

Morphometric and radiomorphometric study of the correlation between the foramen magnum region and the anterior and posterolateral approaches to ventral intradural lesions

Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions

Anterior pontine cavernoma: what should be done?

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