Fehrenbach M K, Kuzman P, Quaeschling U, Meixensberger J, Nestler U
Department of Neurosurgery, University Clinic of Leipzig, Leipzig 04103, Germany.
Department of Neuropathology, University Clinic of Leipzig, Leipzig 04103, Germany.
Int Med Case Rep J. 2019 Aug 6;12:249-252. doi: 10.2147/IMCRJ.S214917. eCollection 2019.
Cerebral cavernous malformations occur in 0.5% of the population. They consist of thin-walled vessels and can be found as congenital or sporadic lesions. Most of them are asymptomatic, however, due to their anatomical features blood leakage into the surrounding tissue can cause severe neurological symptoms. Although risk of bleeding is low, symptomatic lesions should be treated, with microsurgical resection being the therapy of choice for surgically accessible cavernomas. Intraventricular cavernous malformations are a rare subtype, and due to their anatomical localization, they are eligible for endoscopic surgery. However, there are only a few reports on endoscopic resection of intraventricular cavernomas to be found in the literature. We report the case of a 48-year-old woman who suffers from multiple cerebral cavernous malformations. Since the first diagnosis, several of these cavernomas had been removed in open microsurgical interventions. Most recently, a new lesion arose intraventricularly, adjacent to the ependymal wall of the right lateral ventricle. In follow-up, cranial MR imaging microbleeding and an increasing size were detected. Eventually, the lesion was endoscopically removed. Presurgery the patient suffered from right-sided sensibility loss and gait disturbances as a consequence of prior surgeries. Postsurgery, no new neurological symptoms could be found. We here present MR images and intraoperative pictures as well as a short video of the resection itself. In our opinion, endoscopic resection of intraventricular cavernomas should be considered in selected cases.
脑海绵状血管畸形在0.5%的人群中出现。它们由薄壁血管组成,可表现为先天性或散发性病变。大多数是无症状的,然而,由于其解剖特征,血液渗漏到周围组织可导致严重的神经症状。虽然出血风险低,但有症状的病变应予以治疗,显微手术切除是可手术切除的海绵状血管瘤的首选治疗方法。脑室内海绵状血管畸形是一种罕见的亚型,由于其解剖定位,适合内镜手术。然而,文献中关于脑室内海绵状血管瘤内镜切除的报道很少。我们报告一例48岁患有多发性脑海绵状血管畸形的女性病例。自首次诊断以来,其中一些海绵状血管瘤已在开放性显微手术中切除。最近,在右侧脑室室管膜壁附近脑室内出现了一个新病变。随访中,头颅磁共振成像检测到微出血和病变增大。最终,该病变通过内镜切除。术前患者因先前手术出现右侧感觉丧失和步态障碍。术后未发现新的神经症状。我们在此展示磁共振图像、术中图片以及切除过程的短视频。我们认为,在某些特定病例中应考虑脑室内海绵状血管瘤的内镜切除。