Kalani M Yashar S, Couldwell William T
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States.
J Neurol Surg B Skull Base. 2018 Dec;79(Suppl 5):S415-S417. doi: 10.1055/s-0038-1669981. Epub 2018 Sep 25.
This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem. The link to the video can be found at: https://youtu.be/aIw-O2Ryleg .
本视频展示了一名52岁男性的病例，该患者有中脑外侧脑海绵状畸形多次出血史，此次表现为突发头痛、步态不稳以及左侧运动和感觉障碍。该病变位于右侧偏心位置，位于脑桥背外侧。因此，通过右侧极外侧小脑幕下（exSCIT）开颅术并在监测颅神经的情况下对病变进行处理。本视频展示了exSCIT在切除脑桥背外侧病变中的应用，以及这种方法如何使外科医生能够方便地进入小脑上间隙和桥小脑角池。通过这种方法可以进入中脑外侧安全进入区；它由小脑上动脉分支、第四颅神经与中脑外侧沟静脉的交点确定。展示了从脑干逐块切除病变的技术。在脑干内或其附近进行手术时，精心挑选患者并尊重正常解剖结构对于获得良好预后至关重要。视频链接为：https://youtu.be/aIw-O2Ryleg 。
