Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
Neurosurgery. 2011 Jul;69(1):E230-8; discussion E238. doi: 10.1227/NEU.0b013e31821cb28f.
Cavernous malformations (CMs) arising intrinsically to the cisternal segment of the trochlear nerve are extremely rare. This case of a trochlear nerve cavernous angioma is the third to be reported in the neurosurgical literature and the first to be resected by a middle fossa approach.
The authors present a case of a 31-year-old woman with progressive left-sided headache and left hemisensory symptoms, whose magnetic resonance imaging showed a solid enhancing tumor in the left ambient cistern at the level of the midbrain-pontine junction causing significant brainstem compression. Intraoperatively, a left trochlear nerve cavernous angioma circumferentially enveloping the nerve was visualized. The angioma was microsurgically resected by a middle fossa approach under frameless stereotactic guidance. Gross total resection of the intrinsic trochlear nerve lesion was achieved, although the trochlear nerve could not be preserved intact.
CMs should be considered in a possible differential diagnosis of cisternal trochlear nerve tumors. Surgical resection remains the standard of care, and is indicated for relief of compressive symptoms and prevention of future bleeds. Postoperative diplopia often persists; however, resolution of diplopia reported in the literature can be attributed to either regeneration after direct surgical repair of the sacrificed nerve or a spontaneous adaptation over time.
起源于滑车神经池段的海绵状血管畸形极为罕见。本文报告的第三例经神经外科文献报道的滑车神经海绵状血管瘤，也是首例经中颅窝入路切除的病例。
作者报告了一例 31 岁女性患者，渐进性左侧头痛和左侧半感觉症状，其磁共振成像显示中脑-脑桥交界处左侧环池内有实性增强肿瘤，导致明显脑干受压。术中发现左侧滑车神经被环绕的海绵状血管畸形。在无框架立体定向引导下，采用中颅窝入路行显微切除术。尽管未能完整保留滑车神经，但实现了对固有滑车神经病变的大体全切除。
在可能的鞍旁滑车神经肿瘤鉴别诊断中应考虑到海绵状血管畸形。手术切除仍然是标准治疗方法，适用于缓解压迫症状和预防未来出血。术后复视常持续存在；然而，文献中报道的复视缓解可归因于受牺牲神经的直接手术修复后的再生，或随着时间的推移的自发适应。
