Resection of Quadrigeminal Midbrain Cavernous Malformation Using the Supracollicular Safe Entry Zone

ElsevierVolume 169, January 2023, Page 51World NeurosurgeryAuthor links open overlay panel

Brainstem cavernous malformations (BSCMs) are rare and challenging neurosurgical lesions that demand a sophisticated and nuanced strategy for resection. A key element of surgical planning for BSCM resection is brainstem safe entry zones, a set of neuroanatomically defined locations where a pial resection can be executed with minimal risk to the adjacent central nervous system tracts and nuclei.1, 2, 3, 4, 5 Quadrigeminal BSCMs are particularly unusual and can be accessed via the supra-, inter-, or infracollicular safe entry zones.2,4,5 We report a unique demonstration of the supracollicular safe entry zone for the resection of a symptomatic hemorrhagic quadrigeminal plate BSCM. A man in his early 60s presented with transient hearing loss and visual dysfunction. A right quadrigeminal midbrain cavernous malformation was identified on magnetic resonance imaging. Surgical resection was performed with the patient in the sitting position. A bipedicular suboccipital flap, torcular craniotomy, and midline supracerebellar infratentorial approach were used. The lesion itself was accessed via the supracollicular safe entry zone, where pial hemosiderin staining was also encountered, using a linear transverse incision just above the right superior colliculus. Gross total resection was achieved, and the patient recovered from surgery with no new neurologic deficits (Video 1).

Section snippetsSupplementary Data

. Key educational points for this operative video include strategies for resection of a quadrigeminal brainstem cavernous malformation; overview of the positioning, incision, craniotomy, and approach; anatomic and lesional cues for safe brainstem entry; and demonstration of brainstem cavernous malformation resection technique. (Used with permission from Barrow Neurological Institute, Phoenix, Arizona.)

Acknowledgments

We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript and video preparation.

References (5)

There are more references available in the full text version of this article.

View full text

© 2022 Elsevier Inc. All rights reserved.

留言 (0)

沒有登入
gif