Miyahara Kosuke, Okada Tomu, Tanino Shin, Uriu Yasuhiro, Tanaka Yusuke, Suzuki Koji, Sekiguchi Noriaki, Noda Naoyuki, Ichikawa Teruo, Fujitsu Kazuhiko
Department of Neurosurgery, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
Surg Neurol Int. 2023 Jun 2;14:191. doi: 10.25259/SNI_38_2023. eCollection 2023.
Extra-axial cerebellopontine angle (CPA) hemangioblastomas are rare clinical entity and surgical treatment is challenging due to the anatomical difficulties and multi-directional blood supplies. On the other hand, the risk of endovascular treatment for this disease has also been reported. Herein, we successfully applied a posterior transpetrosal approach to remove a large solid CPA hemangioblastoma without preoperative feeder embolization.
A 65-year-old man presented with a complaint of diplopia during downward gaze. Magnetic resonance imaging revealed a solid tumor with homogeneous enhancement measuring about 35 mm at the left CPA, and the tumor compressed a left trochlear nerve. Cerebral angiography disclosed tumor-staining fed by both left superior cerebellar and left tentorial arteries. After the operation, the patient's trochlear nerve palsy improved dramatically.
This approach offers more optimal surgical working angle to the anteromedial part compared to the lateral suboccipital approach. In addition, the devascularization from the cerebellar parenchyma can be performed more reliably than the anterior transpetrosal approach. After all, this approach can be particularly useful when vascular-rich tumors receive blood supplies from multiple directions.
轴外小脑桥脑角（CPA）血管母细胞瘤是一种罕见的临床实体，由于解剖结构复杂和多方向血供，手术治疗具有挑战性。另一方面，也有报道称该疾病进行血管内治疗存在风险。在此，我们成功应用后经岩骨入路切除了一例大型实性CPA血管母细胞瘤，且未进行术前供血动脉栓塞。
一名65岁男性因向下注视时复视而就诊。磁共振成像显示左侧CPA有一个大小约35mm的实性肿瘤，呈均匀强化，肿瘤压迫左侧滑车神经。脑血管造影显示肿瘤染色由左侧小脑上动脉和左侧天幕动脉供血。术后，患者的滑车神经麻痹明显改善。
与枕下外侧入路相比，该入路为前内侧部分提供了更理想的手术操作角度。此外，与经岩骨前入路相比，从脑实质进行去血管化操作可以更可靠地进行。毕竟，当富含血管的肿瘤接受多方向血供时，这种入路可能特别有用。
