Endoscopic Endonasal Transclival Resection of a Brainstem Cavernoma: A Detailed Account of Our Technique and Comparison with the Literature
Endoscopic Endonasal Transclival Resection of a Brainstem Cavernoma: A Detailed Account of Our Technique and Comparison with the Literature
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DOI：
10.1016/j.wneu.2015.08.029
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发表时间：
2015-12-01
影响因子：
2
通讯作者：
Oertel, Joachim
中科院分区：
文献类型：
--
作者：
Linsler, Stefan;Oertel, Joachim
目的：报道一种内窥镜下经斜坡切除表现为脑桥腹侧出血性脑干海绵状畸形的手术方法。方法：1例29岁女性患者，表现为右臂和右腿麻木、刺痛，失去精细运动控制。磁共振成像显示腹侧脑干腹侧有一个海绵状肿瘤。采用纯内窥镜、鼻内窥镜、经斜面入路切除此海绵状肿瘤。使用CT/MRI联合导航(StealthStation，Medtronic)。结果：患者术后无神经功能障碍。运动失控和刺痛感消失。她没有出现任何并发症。脑脊液渗漏似乎是由于使用非常小的颅底和硬脑膜开口造成的，并是使用腰椎引流管几天的原因。在6周的随访检查中，患者情况良好，没有神经功能缺陷，已经恢复了她的全职工作。结论：描述了一例脑干海绵状畸形的成功的内窥镜、鼻内鼻、经斜坡切除。该患者术后神经系统症状改善，无并发症发生。内窥镜颅底入路的技术进步为脑干病变提供了途径，而这些病变以前需要更具侵入性的入路。经鼻内斜入路是最直接到达脑桥腹侧病变的入路。脑干海绵状畸形的早期干预是必要的，考虑到可能的并发症，应采用个体化的治疗方法。
OBJECTIVE: To report a technique of endoscopic transclival resection of a hemorrhagic brainstem cavernous malformation manifesting in the ventral pons.METHODS: A 29-year-old woman presented with numbness and tingling of the right arm and leg and loss of fine motor control. Magnetic resonance imaging revealed a cavernoma in the ventromedial brainstem on the ventral surface. A purely endoscopic, endonasal, transclival approach was used to resect this cavernoma. Computed tomography/magnetic resonance imaging merged navigation (StealthStation, Medtronic) was used.RESULTS: The patient had no neurologic deficits post-operatively. The motor control loss and tingling disappeared. She did not experience any complications. Cerebrospinal fluid leakage appeared to result from using the very small opening of the skull base and dura mater and was the reason for the use of a lumbar drain for several days. At the 6-week follow-up examination, the patient was in excellent condition with no neurologic deficits and had returned to her full-time job.CONCLUSIONS: Successful endoscopic, endonasal, transclival resection of a brainstem cavernous malformation was described. This patient experienced improvement in neurologic symptoms after surgery without morbidity. Technologic advances in endoscopic skull base approaches provide access to lesions of the brainstem that previously required more invasive approaches. The endonasal transclival approach provides the most direct route to ventral pontine lesions. Early intervention in brainstem cavernous malformation is indicated and should be performed with an individualized approach taking into consideration the possible complications.