Cavallo Luigi M, Berardinelli Jacopo, Bove Ilaria, Somma Teresa, Cirillo Mario, Esposito Felice
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
J Neurosurg Case Lessons. 2025 Sep 1;10(9). doi: 10.3171/CASE25356.
Brainstem cavernous malformations (BSCMs) are rare vascular lesions, most frequently located in the pons. Their surgical management is particularly demanding due to the dense concentration within the brainstem of eloquent neural pathways and nuclei. Among various surgical routes, the endoscopic endonasal transclival approach (EETA) has been established as a valuable option for treating selected ventrally located lesions.
The authors report the case of a 54-year-old woman with a ventral pontine cavernous malformation (CM) presenting with recurrent hemorrhagic episodes, all resolving without neurological sequelae. Based on the anterior midline location of the lesion within the pons and the posterolateral displacement of the corticospinal tracts (CSTs) on preoperative tractography, an EETA was deemed the most suitable approach. Gross-total removal was achieved without neurological worsening or postoperative CSF leakage.
This case supports the use of EETA as a safe and effective surgical route for ventral pontine CMs with anterior surface presentation. Accurate preoperative planning, including assessment of CST displacement via diffusion tensor imaging, and direct intraoperative cortical stimualtion are essential for identifying a safe entry point. Although technically demanding and not universally applicable, EETA offers a direct surgical corridor that minimizes neurovascular manipulation and facilitates favorable outcomes in selected cases. https://thejns.org/doi/10.3171/CASE25356.
脑干海绵状畸形（BSCMs）是罕见的血管病变，最常位于脑桥。由于脑干内明确的神经通路和神经核密集分布，其手术治疗要求极高。在各种手术入路中，内镜下经鼻经斜坡入路（EETA）已被确立为治疗某些位于腹侧的病变的一种有价值的选择。
作者报告了一例54岁女性，患有腹侧脑桥海绵状畸形（CM），反复出现出血发作，所有发作均未遗留神经后遗症而缓解。基于病变在脑桥内的前中线位置以及术前神经纤维束成像显示的皮质脊髓束（CSTs）后外侧移位，EETA被认为是最合适的入路。实现了全切，且无神经功能恶化或术后脑脊液漏。
该病例支持将EETA作为治疗腹侧表面型脑桥CM的一种安全有效的手术途径。准确的术前规划，包括通过弥散张量成像评估CST移位以及术中直接进行皮质刺激，对于确定安全的入点至关重要。尽管技术要求高且并非普遍适用，但EETA提供了一条直接的手术通道，可将神经血管操作降至最低，并在特定病例中促进良好的手术效果。https://thejns.org/doi/10.3171/CASE25356。
