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J Neurol Surg B Skull Base 2023; 84(02): 192-193
DOI: 10.1055/a-1775-1207
Original Article

Large Pontine Cavernoma Operated by Anterior Petrosal Approach—Two-Dimensional Operative Video

Leonardo Desessards Olijnyk
1   Department of Neurosurgery, Ernesto Dornelles Hospital, Porto Alegre, Brazil
,
Adriana Azeredo Coutinho Abrão
1   Department of Neurosurgery, Ernesto Dornelles Hospital, Porto Alegre, Brazil
,
Carlos Eduardo da Silva
1   Department of Neurosurgery, Ernesto Dornelles Hospital, Porto Alegre, Brazil
2   Federal Health Science University of Porto Alegre - UFCSPA, Porto Alegre, Brazil
› Author Affiliations Funding None.
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Abstract

Brainstem cavernoma is a challenging neurosurgical pathology and microsurgery remains the only treatment option. Although the decision-making between interventional and conservative approach to this disease may be complex, malformations presenting multiple bleedings are usually good candidates for surgery.[1] On the other hand, microsurgical resection of cavernomas can offer an effective resolution with acceptable morbidity.

In this video, we present a case of pontine cavernoma with multiple hemorrhages in a young patient. The anatomical characteristic of the lesion defines the best suitable craniotomy for surgery. In this case, an anterior petrosal approach[2] [3] [4] was used to access the peritrigeminal area and safely perform the resection. Anatomical considerations are described on this skull base approach along with the rationale and benefits of this exposure. Electrophysiological neuromonitoring is essential for this kind of procedure and preoperative tractography also enabled the best understanding of the disease. Finally, we also discuss alternative managements and potential complications.[5]

With the patient's consent, we also show the excellent clinical evolution after few weeks of recovery and the restoration of the corticospinal tract, previously displaced by the cavernoma, to its original position.

Keywords

brainstem cavernoma - anterior petrosal approach

Note

The patient consented to the publication of his imaging.




Publication History

Received: 08 November 2021

Accepted: 14 February 2022

Accepted Manuscript online:
17 February 2022

Article published online:
20 May 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Garrett M, Spetzler RF. Surgical treatment of brainstem cavernous malformations. Surg Neurol 2009; 72 (Suppl. 02) S3-S9 , discussion S9–S10
    CrossrefPubMedGoogle Scholar
  • 2 Ribas GC, Rodrigues AJ. The suprapetrosal craniotomy. J Neurosurg 2007; 106 (03) 449-454
    CrossrefPubMedGoogle Scholar
  • 3 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (06) 857-861
    CrossrefPubMedGoogle Scholar
  • 4 Kadri PAS, Essayed WIBN, Al-Mefty O. Resection of pontine cavernoma through the anterior transpetrosal approach: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2021; 21 (01) E26-E27
    CrossrefPubMedGoogle Scholar
  • 5 Park K, Kim JW, Chung HT, Paek SH, Kim DG. Long-term outcome of gamma knife radiosurgery for symptomatic brainstem cavernous malformation. World Neurosurg 2018; 116: e1054-e1059
    CrossrefPubMedGoogle Scholar