Liu James K, Dodson Vincent N
Department of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, RWJ Barnabas Health Newark, New Jersey.
Neurosurg Focus Video. 2019 Jul 1;1(1):V18. doi: 10.3171/2019.7.FocusVid.19229. eCollection 2019 Jul.
Brainstem cavernous malformations are formidable lesions because of their eloquent location and propensity for bleeding resulting in neurological impairment. The surgical management can be challenging due to their deep location around critical neurovascular structures. In this operative video manuscript, the authors demonstrate resection of a large recurrent pontine cavernous malformation with an exophytic component in the cerebellopontine angle via a combined petrosal approach. Both anterior and posterior (retrolabyrinthine) petrosectomies were performed to allow multi-corridor access to the lesion. Due to excessive scar formation from prior surgeries, sharp dissection was paramount to create dissection planes around the lesion. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, safe resection of the malformation through the operative corridor, gentle handling of the neurovascular structures and a multi-layered reconstruction technique to prevent cerebrospinal fluid leakage. The use of endoscopic-assisted microsurgery of the brainstem is also demonstrated. A gross total resection was achieved, and the patient improved neurologically. In summary, the combined petrosal approach with endoscopic assistance is an important strategy in the armamentarium for the surgical management of brainstem cavernous malformations. The video can be found here: https://youtu.be/oAETW6tVc_Y.
脑干海绵状血管畸形是一种严重的病变，因其位置关键且容易出血，进而导致神经功能障碍。由于其位于关键神经血管结构周围的深部位置，手术治疗颇具挑战性。在这份手术视频文稿中，作者展示了通过联合岩骨入路切除一例位于脑桥小脑角、带有外生性成分的大型复发性脑桥海绵状血管畸形。同时进行了前侧和后侧（迷路后）岩骨切除术，以便从多个通道接近病变。由于既往手术造成过多瘢痕形成，锐性分离对于在病变周围创建分离平面至关重要。本视频图谱展示了颅底入路的手术技术和手术细节、通过手术通道安全切除畸形、轻柔处理神经血管结构以及防止脑脊液漏的多层重建技术。还展示了脑干内镜辅助显微手术的应用。实现了全切，患者神经功能得到改善。总之，并联合岩骨入路加内镜辅助是脑干海绵状血管畸形手术治疗手段中的一项重要策略。视频可在此处查看：https://youtu.be/oAETW6tVc_Y 。
