Department of Neurosurgery and Otolaryngology, University of Florida, Gainesville, Florida 32610-0261, USA.
Neurosurgery. 2012 Sep;71(1 Suppl Operative):186-93; discussion 193-4. doi: 10.1227/NEU.0b013e31824cabb1.
Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation.
A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection.
The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.
脑干海绵状血管畸形在决定何时手术时存在困境，并且仍然难以进行手术切除。我们提出了一种新的脑干海绵状血管畸形切除术方法。
一名 59 岁女性因间歇性构音障碍、右侧面部无力和左侧手臂及腿部无力，持续 1 个月而就诊。磁共振成像显示桥脑有一个 2cm 的肿块，其内有不同时期的血液产物，符合海绵状血管畸形的表现。我们与她讨论了手术切除和保守治疗的风险。她决定选择保守治疗。两周后，她因复视和左侧偏瘫返回急诊室。可见右侧桥脑内急性出血。随后，她选择进行手术切除。
患者接受了内镜经鼻入路切除桥脑海绵状血管畸形。图像引导用于识别关键解剖标志。实现了大体全切除，且无新的神经功能缺损。经物理治疗和职业治疗，患者在出院前发展出左侧上下肢的抗重力力量。在 4 周随访时，她在拐杖的辅助下独立行走。我们报告了一例通过内镜经鼻入路成功切除桥脑海绵状血管畸形。该患者在接受手术切除后，神经症状有所改善，手术并发症很少。内镜颅底入路的技术进步为以前需要更具侵袭性方法的颅底病变提供了通路。
