Microsurgical Treatment of Intraventricular Cavernoma with Prior Planning Neuroendoscopy

Abstract

Microsurgery remains the gold standard treatment for intraventricular lesions, but it is not without limitations. The cerebral ventricles approach is considered a challenge for neurosurgeons because of their deep location and their intimate association with critical areas of the brain. It has been shown that direct endoscopic view is superior to magnetic resonance imaging (MRI) in identifying intraventricular structures and lesions. Also, during neuroendoscopy, there is no cerebrospinal fluid leak causing brain collapse as seen in microsurgery. Different surgical strategies should be shared and may improve and facilitate intraventricular lesions resection. Herein, a case of a successful microsurgical cavernoma resection with prior ventriculoscopy is described. A 28-year-old woman was admitted with intense holocranial headache. A mild stiff neck was observed. MRI showed a 3-cm lesion with heterogeneous signal intensity and no contrast enhancement suggestive of cavernoma. Initially, a ventriculoscopy was done to inspect the lesion and the surrounding ventricular structures. After that, a conversion technique from endoscopy to microsurgery was performed. The initial corticectomy was extended and the endoscope pathway was followed into the ventricular cavity. Then, the cavernoma was completely removed by microsurgical technique. No complications were observed. Control MRI showed total tumour removal. The patient remained asymptomatic with no recurrence after 1 year. This case illustrates a successful prior endoscopic approach followed by microsurgery as an alternative to a direct microsurgical approach for intraventricular cavernoma. A previous direct endoscopic view of the lesion and its relation with intraventricular structures may ensure a safe and complete resection by microsurgery.

Hemorrhage of a Cavernous Hemangioma of the Brainstem Presenting with Fever of Unknown Origin: A Case Report

“…Stereotactic radiosurgery may be considered as a therapeutic alternative for lesions that are surgically inaccessible [ 11 , 12 ] because it is highly accurate and allows targeted delivery of high-dose radiation with sparing of adjacent, healthy brain parenchyma. The ventricular region surgery is considered a challenge due to the deep location and the intimate association of the cerebral ventricles with critical areas of the brainstem [ 13 ]. Hyperthermia of central origin has been described in various hemorrhagic conditions of the CNS, usually presenting with acute neurologic deficits or meningismus; its pathophysiology usually involving the preoptic area of the hypothalamus [ 14 ].…”

Intraventricular Cavernoma

“…The prevalence in the general population is 0.02 to 0.13% and accounts to 5 to 13% of the central nervous system vascular malformations [2]. IVC are uncommon entities comprising 2.5-10.8% of all brain cavernous malformations [1], and only about 136 well-documented cases have been published [3]. The lateral ventricles are the most frequent site followed by third and fourth ventricle [4].…”

“…Cerebral cavernomas are most commonly identifi ed brain vascular malformation majority of which are located in the brain parenchyma. Intraventricular cavernomas are rare accounting for 2.5-10.8% of cerebral cavernomas [1]. They are detected incidentally or may present with a headache, seizures, hemorrhage, hydrocephalus or neurological defi cits.…”