Endoscopic, Endonasal, Transclival Resection of a Pontine Cavernoma: Case Report
Endoscopic, Endonasal, Transclival Resection of a Pontine Cavernoma: Case Report
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DOI：
10.1227/neu.0b013e318259e323
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发表时间：
2012-09-01
期刊：
影响因子：
4.8
通讯作者：
Lee, John Y. K.
中科院分区：
文献类型：
--
作者：
Sanborn, Matthew R.;Kramarz, Michael J.;Lee, John Y. K.
背景和重要性：脑干内出血性、症状性海绵状血管畸形很难进入。传统的方法，如经岩骨入路，往往需要显着的脑回缩。我们提出了成功的纯内镜下，鼻内，translival切除的症状海绵状血管瘤位于ventromedial脑桥介绍：一个17岁的男性患者出现急性发作的头痛，面部麻木，刺痛。磁共振成像显示在脑桥增强病变符合海绵状血管畸形。在接下来的3周内，患者发生了另外2次神经功能缺损急性恶化，导致左侧轻偏瘫、右侧第六神经麻痹和吞咽困难。一个纯粹的内窥镜下，鼻内，经肝门途径被用来切除海绵状血管瘤。术后，他的左侧运动功能短暂恶化，水平凝视受限，但在末次随访时，他的轻偏瘫改善，磁共振成像显示放射学治愈。尽管预防性腰椎CSF引流2天并使用双侧血管化鼻中隔瓣，但患者仍发生脑脊液（CSF）漏。脑脊液漏修复与脑脊液分流和第二次手术，在最后一次随访，他没有复发的leak.CONCLUSION：内窥镜下，鼻内，translival方法是一种新的和有效的方法海绵状血管畸形提出的腹侧表面的脑桥。最近开发的颅底缺损闭合和修复技术已最大限度地降低了这些手术中CSF泄漏的风险，但尚未消除。
BACKGROUND AND IMPORTANCE: Hemorrhagic, symptomatic cavernous malformations in the brainstem are difficult to access. Conventional approaches such as the transpetrosal approach often require significant brain retraction. We present the successful purely endoscopic, endonasal, transclival resection of a symptomatic cavernoma located in the ventromedial pons.CLINICAL PRESENTATION: A 17-year-old male patient presented with acute onset of headache, facial numbness, and tingling. Magnetic resonance imaging demonstrated an enhancing lesion in the pons consistent with a cavernous malformation. Over the course of the next 3 weeks, the patient had 2 additional episodes of acutely worsening neurological deficits that left him with left-sided hemiparesis, a right sixth nerve palsy, and dysphagia. A purely endoscopic, endonasal, transclival approach was used to resect the cavernoma. Postoperatively, he had a transient worsening of his left-side motor function and restricted horizontal gaze, but at the last follow-up, his hemiparesis had improved and his magnetic resonance imaging demonstrated a radiographic cure. He developed a cerebrospinal fluid (CSF) leak despite prophylactic lumbar CSF drainage for 2 days and the use of bilateral vascularized nasoseptal flaps. The CSF leak was repaired with CSF diversion and a second surgical procedure; at the last follow-up, he had no recurrence of the leak.CONCLUSION: An endoscopic, endonasal, transclival approach is a novel and effective approach to cavernous malformations presenting to the ventral surface of the pons. Recently developed techniques for closure and repair of the skull base defect have minimized but have not eliminated the risk of CSF leak in these procedures.