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16.02.2020 | How I Do it - Neurosurgical technique evaluation

Transmastoid presigmoid retrolabyrinthine approach for removal of pontine cavernous malformation: how I do it

Zeitschrift:
Acta Neurochirurgica
Autoren:
Yu-Chiang Yeh, Kuo-Chen Wei, Ko-Ting Chen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-020-04263-3) contains supplementary material, which is available to authorized users.
This article is part of the Topical Collection on Neurosurgical technique evaluation
Summary of 10 Key Points
1. Transmastoid presigmoid retrolabyrinthine approach is the shortest route and provide direct approach to lateral pontine zone of brainstem.
2. Lateral pontine zone is a safe entry zone to resect lateral pontine lesions.
3. Transmastoid approach without a need of craniotomy is efficient and effective in selected cases.
4. Neuronavigation system incorporating with high resolution CT (temporal bone) and brain MRI provides valuable anatomical information in petrosal approach for BSCMs.
5. Intraoperative neurophysiological monitoring provides valuable physiological information before, during, and after BSCM removal.
6. Temporalis fascia graft is useful to close presigmoid dura defect.
7. Tissue glue provides extra-support to prevent CSF leakage.
8. Bone wax should be used to cover the drilled rough surface of petrous bone.
9. A generous fat graft should be harvested to plug into the drilled aeration dead space, which provides support to dura graft and decreases risk of CSF leakage and CNS infection.
10. A cosmetic mastoid cortical bone reconstruction is suggested.

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Abstract

Background

Bleeding of brainstem cavernous malformations (BSCM) cause high morbidity and should be treated surgically whenever possible.

Method

We present a 56-year-old man, who was diagnosed with a BSCM at right pons, which caused functional impairments of dorsal column, spinothalamic tract, cochlear nucleus, and middle cerebellar peduncle. A transmastoid presigmoid retorlabyrinthine approach via the lateral pontine zone (LPZ), with an assistance of imaging guidance and intraoperative neurophysiological monitoring, was performed to completely resect the BSCM. The patient recovered despite a transient worsening of cerebellar sign and hemiparesthesia for 1 week, without surgical complications.

Conclusions

A transmastoid presigmoid retrolabyrinthine approach through LPZ is safe and effective for lateral pontine BSCM resection.

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