Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):26-9; discussion 29. doi: 10.1227/01.NEU.0000350865.85697.18.
We describe the lateral transpeduncular approach to access lesions in the rostral pons. The surgical indications and technique are discussed in the context of an illustrative case and pertinent anatomic considerations.
A 38-year-old man with acute right hemiparesis and bulbar symptoms had a left pontine hemorrhage with an associated cavernous malformation and venous anomaly. There was no pial or ependymal representation of the lesion. To avoid disruption of eloquent structures, the pia was entered in the posterolateral aspect of the middle cerebellar peduncle. Subsequent dissection was guided by stereotactic neuronavigation in a ventromedial trajectory along the course of the pontocerebellar fibers.
The cavernous malformation was resected completely without procedure-related morbidity. The patient's preoperative deficits slowly improved to a functionally independent state.
The lateral transpeduncular approach may be used to access intrinsic lesions of the rostral pons with relatively low morbidity. Stereotactic neuronavigation and intraoperative electrophysiological monitoring are important surgical adjuncts to guide dissection and lesion extirpation. Candidate selection, microsurgical technique, and pragmatic treatment goals remain fundamental to optimal patient outcomes.
我们描述了经侧方豆状核入路来处理桥脑前段的病变。本文结合一个病例和相关解剖学因素讨论了手术适应证和技术。
一位 38 岁男性，因急性右侧偏瘫和球部症状而就诊，其左侧桥脑出血，伴发海绵状血管畸形和静脉异常。病变没有软脑膜或室管膜代表。为避免破坏功能区结构，我们在中脑小脑脚的后外侧进入软膜。随后，在立体定向神经导航的引导下，沿着桥脑小脑纤维的走行，采用腹侧入路进行了向内侧的分离。
完全切除了海绵状血管畸形，且无手术相关的发病率。患者术前的缺陷缓慢改善，达到了功能独立的状态。
经侧方豆状核入路可以用来处理桥脑前段的固有病变，其发病率相对较低。立体定向神经导航和术中电生理监测是指导分离和病变切除的重要手术辅助手段。候选者选择、显微外科技术和务实的治疗目标仍然是获得最佳患者预后的基础。
