Endoscopic endonasal transclival approach for resection of a pontine cavernous malformation

Lima, Lucas Ramos Costa; Reis, Jarbas Carvalhais; Vieira, Gerival; Vieira, Tiago Fraga; Filho, Lucídio Duarte de Souza; Carvalho, Tiago Silva e; Marques, Fabricio Nery; Lago, Ramon Souza; Santana, Thiago Vinícius Muniz

doi:10.3171/2019.7.focusvid.19212

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…The CSF rhinorrhea occurred on the 5th postoperative day when the Foley catheter was removed, after the lumbar drainage failed, the same reconstruction strategy was re-performed, the patient suffered no further CSF leakage [ 28 ]. The patient presented with a CSF leakage on the 6th postoperative day, the reconstruction layers were repositioned and fixed with fibrin glue and a Foley catheter, and lumbar drainage was performed [ 23 ]. Postoperative CSF leakage was observed in one of five patients in Takeuchi K’s report, which was resolved by replacing the abdominal subcutaneous fat graft and overlaying it with a nasoseptal flap [ 29 ].…”

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confidence: 99%

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Hu,

Tang,

2024

BMC Surg

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Background Brainstem cavernous malformations (BCMs) are benign lesions that typically have an acute onset and are associated with a high rate of morbidity. The selection of the optimal surgical approach is crucial for obtaining favorable outcomes, considering the different anatomical locations of various brainstem lesions. Endoscopic surgery is increasingly utilized in treating of BCMs, owing to its depth illumination and panoramic view capabilities. For intra-axial ventral BCMs, the best surgical options are endoscopic endonasal approaches, following the “two-point method. For cavernous hemangiomas on the dorsal side of the brainstem, endoscopy proves valuable by providing enhanced visualization of the operative field and minimizing the need for brain retraction. Methods In this review, we gathered data on the fully endoscopic approach for the resection of BCMs, and outlined technical notes and tips. Total of 15 articles were included in this review. The endoscopic endonasal approach was utilized in 19 patients, and the endoscopic transcranial approach was performed in 3 patients. Results The overall resection rate was 81.8% (18/22). Among the 19 cases of endoscopic endonasal surgery, postoperative cerebrospinal fluid (CSF) leakage occurred in 5 cases, with lesions exceeding 2 cm in diameter in 3 patients with postoperative CSF rhinorrhea. Among the 20 patients with follow-up data, 2 showed no significant improvement after surgery, whereas the remaining 18 patients showed significant improvement compared to their admission symptoms. Conclusions This systematic literature review demonstrates that a fully endoscopic approach is a safe and effective option for the resection of BCMs. Further, it can be considered an alternative to conventional craniotomy, particularly when managed by a neurosurgical team with extensive experience in endoscopic surgery, addressing these challenging lesions.

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Section: Discussionmentioning

confidence: 99%

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Hu,

Tang,

2024

BMC Surg

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Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Tang

2023

Preprint

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Brainstem cavernous malformations (BCMs) as a benign lesion, usually has an acute onset and leads to a high rate of morbidity. According to the different anatomical sites of various brainstem lesions, the selection of the optimal surgical approach is the premise of obtaining favorable surgical outcomes. Due to the depth illumination and panoramic view of endoscope compared with microscope, endoscopic surgery is gradually applied in the treatment of BCMs. For intra-axial ventral BCMs, the best surgical options are endoscopic endonasal approaches according to the “two-point method. For cavernous hemangiomas on the dorsal of the brainstem, the value of endoscopy lies in the better visualization of the operative field provided by the endoscope and the minimization of brain retraction. In this review, we gathered data on the fully endoscopic approach for resection of BCMs, and outline technical notes and tips for this approach. Seventeen cases from a total of 14 articles were included in the present review. The endoscopic endonasal approach was applied in 14 patients, endoscopic transcranial approach was performed in 3 patients. The total resection rate of lesions was 76.5% (14/17). In the 14 cases of endoscopic endonasal surgery, postoperative CSF leakage was found in 4 cases. The maximum diameter of lesion in 3 patients with postoperative CSF rhinorrhea was greater than 2cm. In the 15 patients with follow-up data, 2 patients showed no significant improvement after surgery, the remaining 13 patients showed significant improvement compared with admission. This systematic review of the literature demonstrates that a fully endoscopic approach to the BCMs is a safe and effective option for resection, which can be considered as an alternative to conventional craniotomy for dealing with these challenging lesions by a team of neurosurgeons with extensive experience in endoscopic surgery.

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Endoscopic endonasal transclival approach for resection of a pontine cavernous malformation

Cited by 2 publications

References 7 publications

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

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