Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report

Neurosurgery
Matthew R SanbornJohn Y K Lee

Abstract

Hemorrhagic, symptomatic cavernous malformations in the brainstem are difficult to access. Conventional approaches such as the transpetrosal approach often require significant brain retraction. We present the successful purely endoscopic, endonasal, transclival resection of a symptomatic cavernoma located in the ventromedial pons. A 17-year-old male patient presented with acute onset of headache, facial numbness, and tingling. Magnetic resonance imaging demonstrated an enhancing lesion in the pons consistent with a cavernous malformation. Over the course of the next 3 weeks, the patient had 2 additional episodes of acutely worsening neurological deficits that left him with left-sided hemiparesis, a right sixth nerve palsy, and dysphagia. A purely endoscopic, endonasal, transclival approach was used to resect the cavernoma. Postoperatively, he had a transient worsening of his left-side motor function and restricted horizontal gaze, but at the last follow-up, his hemiparesis had improved and his magnetic resonance imaging demonstrated a radiographic cure. He developed a cerebrospinal fluid (CSF) leak despite prophylactic lumbar CSF drainage for 2 days and the use of bilateral vascularized nasoseptal flaps. The CSF leak was repair...Continue Reading

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Citations

Oct 20, 2018·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Sarah Bin AbdulqaderAbdulrazag Ajlan
Oct 22, 2016·Journal of Neurosurgery·Juan Luis Gómez-AmadorAlfredo Vega-Alarcón
Jan 14, 2017·Journal of Neurosurgery·Walid I EssayedTheodore H Schwartz
Dec 14, 2019·Operative Neurosurgery·Mina M GergesTheodore H Schwartz
Jul 14, 2019·Operative Neurosurgery·Daniel G EichbergRobert M Starke
Sep 19, 2019·Neurosurgical Review·Joachim OertelStefan Linsler

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