American Association of Neurological Surgeons | Endoscopic endonasal approach for brainstem cavernous malformation @AANSNeurosurgery | Uploaded April 2020 | Updated October 2024, 23 hours ago.
Ezequiel Goldschmidt, MD, PhD,1 Andrew S. Venteicher, MD, PhD,1 Maximiliano Nuñez, MD,1
Eric Wang, MD,2 Carl Snyderman, MD,2 and Paul Gardner, MD1
Departments of 1Neurosurgery and 2Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
This 25-year-old woman presented after a second hemorrhage from a mesencephalic cavernous malformation. High-definition fiber tracking demonstrated lateral displacement of the corticospinal tracts, making a midline approach ideal. The lesion appeared to present to the third ventricle, but a transcallosal approach was abandoned due to the posterior third ventricular location and after FIESTA imaging revealed a superior and medial rim of normal parenchyma that would have to be transgressed to access the malformation. An endoscopic endonasal approach with interdural pituitary hemitransposition was performed. The interpeduncular cistern was accessed and the thalamoperforating arteries dissected to access the cavernous malformation that was completely removed in a piecemeal fashion. The patient’s preexisting internuclear ocular palsies and hemiparesis were slightly worsened after surgery as predicted by a drop in anterior tibialis motor evoked potentials. Postoperative MRI showed no infarct, and the hemiparesis was back to baseline at 1-month follow-up.
**Intro music: "Daybreak" by Graeme Rosner
Ezequiel Goldschmidt, MD, PhD,1 Andrew S. Venteicher, MD, PhD,1 Maximiliano Nuñez, MD,1
Eric Wang, MD,2 Carl Snyderman, MD,2 and Paul Gardner, MD1
Departments of 1Neurosurgery and 2Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
This 25-year-old woman presented after a second hemorrhage from a mesencephalic cavernous malformation. High-definition fiber tracking demonstrated lateral displacement of the corticospinal tracts, making a midline approach ideal. The lesion appeared to present to the third ventricle, but a transcallosal approach was abandoned due to the posterior third ventricular location and after FIESTA imaging revealed a superior and medial rim of normal parenchyma that would have to be transgressed to access the malformation. An endoscopic endonasal approach with interdural pituitary hemitransposition was performed. The interpeduncular cistern was accessed and the thalamoperforating arteries dissected to access the cavernous malformation that was completely removed in a piecemeal fashion. The patient’s preexisting internuclear ocular palsies and hemiparesis were slightly worsened after surgery as predicted by a drop in anterior tibialis motor evoked potentials. Postoperative MRI showed no infarct, and the hemiparesis was back to baseline at 1-month follow-up.
**Intro music: "Daybreak" by Graeme Rosner
