Cavalcanti Daniel D, Catapano Joshua S, Niemeyer Filho Paulo
Department of Neurosurgery, NYU School of Medicine, New York, New York.
Department of Radiology, NYU School of Medicine, New York, New York.
Oper Neurosurg (Hagerstown). 2020 Oct 15;19(5):E518-E519. doi: 10.1093/ons/opaa142.
The retrosigmoid approach is one of the main approaches used in the surgical management of pontine cavernous malformations. It definitely provides a lateral route to large central lesions but also makes possible resection of some ventral lesions as an alternative to the petrosal approaches. However, when these vascular malformations do not emerge on surface, one of the safe corridors delimited by the origin of the trigeminal nerve and the seventh-eight cranial nerve complex can be used.1-5 Baghai et al2 described the lateral pontine safe entry zone in 1982, as an alternative to approaches through the floor of the fourth ventricle when performing tumor biopsies. They advocated a small neurotomy performed right between the emergence of the trigeminal nerve and the facial-vestibulocochlear cranial nerves complex. Accurate image guidance, intraoperative cranial nerve monitoring, and comprehensive anatomical knowledge are critical for this approach.4,5 Knowing the natural history of a brainstem cavernous malformation after bleeding,6 we sought to demonstrate in this video: (1) the use of the retrosigmoid craniotomy in lateral decubitus for resection of deep-seated pontine cavernous malformations; (2) the wide opening of arachnoid membranes and dissection of the superior petrosal vein complex to improve surgical freedom and prevent use of fixed cerebellar retraction; and (3) the opening of the petrosal fissure and exposure of the lateral pontine zone for gross total resection of a cavernous malformation in a 19-yr-old female with a classical crossed brainstem syndrome. She had full neurological recovery after 3 mo of follow-up. The patient consented in full to the surgical procedure and publication of the video and manuscript.
乙状窦后入路是桥脑海绵状血管畸形外科治疗的主要入路之一。它无疑为大型中央病变提供了一条外侧入路，同时也使得切除一些腹侧病变成为岩骨入路的替代选择。然而，当这些血管畸形未显露于表面时，可以使用由三叉神经起始部和第Ⅶ-Ⅷ脑神经复合体界定的安全通道之一。1-5 巴盖等人2在1982年描述了桥脑外侧安全入路区，作为在进行肿瘤活检时经第四脑室底入路的替代方法。他们主张在三叉神经和面听神经复合体之间进行小的神经切开术。精确的影像引导、术中脑神经监测和全面的解剖知识对该入路至关重要。4,5 了解脑干海绵状血管畸形出血后的自然病程，6我们试图在本视频中展示：（1）采用侧卧位乙状窦后开颅术切除深部桥脑海绵状血管畸形；（2）广泛打开蛛网膜并解剖岩上静脉复合体，以增加手术操作空间并避免使用固定的小脑牵拉；（3）打开岩骨裂隙并暴露桥脑外侧区，以全切一名患有典型交叉性脑干综合征的19岁女性的海绵状血管畸形。随访3个月后，她神经功能完全恢复。 患者完全同意手术操作及视频和稿件的发表。
