Infratentorial Supracerebellar Approach for Resection of Midbrain Cavernous Malformation: 3-Dimensional Operative Video

Abstract

Cavernous malformations (cavernomas) of the brain stem with recurrent hemorrhage may be amenable to microsurgical resection if they are present close to the surface. The risks of surgery need to be balanced with the natural history of the lesion and the accumulation of neurological deficits and risk to life with multiple hemorrhages. In this 3D operative video, we illustrate the technique for the resection of a dorsally located midbrain cavernous malformation. Informed consent was obtained for this procedure. The cavernoma is accessed with the use of a supracerebellar infratentorial approach. The infratentorial craniotomy and coagulation of the superior vermian veins is shown. A description is provided of the use of hemosiderin staining and the intercollicular relative “safe zone” 1 as landmarks for the neurotomy. The technique of cavernoma dissection from the surrounding gliotic plane is shown and described. In this case, the patient required prolonged rehabilitation but fully recovered without residual deficit 1 yr following surgery.

Anatomical Study and Clinical Application of Neuroendoscopic Transfarlateral Supracerebellar Infratentorial Approach

“…Partial petrous bone must often be ground off to expand exposure and remove residual lesions. [10][11][12] An angled neuroendoscope has the advantage of lateral observation. By adjusting the angle and direction of endoscopy, total resection of the tumor in the hidden part can be realized.…”

“…In addition, because of the poor exposure of lateral deep areas, such as the internal auditory canal and Meckel’s capsule, microscopic observation is limited. Partial petrous bone must often be ground off to expand exposure and remove residual lesions 10-12 . An angled neuroendoscope has the advantage of lateral observation.…”

Commentary: Lateral Supracerebellar, Infratentorial Approach for a Large Midbrain Cavernous Malformation: 2-Dimensional Operative Video

“…n this video article, 1 the authors present a case of 26-year-old male patient suffering from left hemiparesis, gait disturbances, slurred speech, agitation, and diplopia of 2-week duration. It seems that the patient had similar less pronounced symptoms of 6month duration.…”