Keleş Abdullah, Harput Mehmet Volkan, Türe Uğur
Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
Neurosurg Focus Video. 2019 Jul 1;1(1):V15. doi: 10.3171/2019.7.FocusVid.19186. eCollection 2019 Jul.
This video demonstrates resection of a left pontine cavernous malformation that is abutting the floor of the fourth ventricle (f4V). Even though accessing the lesion through the f4V seems to be reasonable, we used a lateral supracerebellar approach through the middle cerebellar peduncle to preserve especially the abducens and facial nuclei. After total resection the patient was neurologically intact at the 3-month follow-up. Postoperative MRI revealed 3.5-mm pontine tissue between the cavity and f4V that appeared to be absent in preoperative MRI. Approaching pontine lesions through the f4V is not the first choice. In our opinion, the philosophy of safe entry zones is a concept to be reassessed. The video can be found here: https://youtu.be/1Jh6giZc-48.
本视频展示了对一个紧邻第四脑室底部（f4V）的左侧脑桥海绵状畸形的切除。尽管通过f4V进入病变似乎合理，但我们采用了经小脑中间脚的外侧小脑上入路，以特别保留展神经和面神经核。全切除术后，患者在3个月随访时神经功能完好。术后MRI显示，在腔隙与f4V之间有3.5毫米的脑桥组织，而术前MRI中该区域似乎不存在。通过f4V处理脑桥病变并非首选。我们认为，安全入路区的理念是一个有待重新评估的概念。视频可在此处查看：https://youtu.be/1Jh6giZc-48 。
