The tonsillouvular fissure approach to exophytic cavernous malformation in the lateral recess of the fourth ventricle: 2-dimensional operative video.

Lasica, Nebojsa; Djilvesi, Djula; Parikh, Kara A

Lasica, Nebojsa; Djilvesi, Djula; Parikh, Kara A.

Afiliación

Lasica N; Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia. Electronic address: nebojsa.lasica@mf.uns.ac.rs.
Djilvesi D; Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.
Parikh KA; Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, TN, USA.

J Clin Neurosci ; 128: 110782, 2024 Oct.

Article en En | MEDLINE | ID: mdl-39178696

ABSTRACT

ABSTRACT

Cavernous malformations surrounding the fourth ventricle are challenging lesions to access and treat surgically owing to the complexity and eloquence of adjacent neural tissue [1] Long-standing practice included tissue transgression through the overlying cerebellar cortical surface of the hemisphere or vermis [1-3]. Using natural corridors such as tonsillobiventral fissure, cerebellomedullary fissure, and tonsillouvular fissure (TUF) offers elegant access to the fourth ventricle, avoiding traversing of neural tissue [4-7]. A 32-year-old male presented with headache, nausea, vomiting, double vision, and vertigo. Neuroimaging demonstrated a 17-mm diameter cavernous malformation protruding into the left lateral recess of the fourth ventricle. The patient consented for the procedure and underwent a middline suboccipital craniotomy in a prone position. TUF approach was performed by dissecting the arachnoid to the depth of the fissure, and after identifying the tonsillomedullary segment of the posterior inferior cerebellar artery, minimal white matter transgression was used to reach cavernous malformation. Complete removal of the lesion was achieved and confirmed on postoperative imaging. The postoperative course was uneventful. TUF approach with manipulation by ipsilateral and contralateral retraction of tonsills allows the widening of the surgical corridor and better exposure of lesions of the lateral recess of the fourth ventricle [1]. TUF approach is a valuable alternative to transvermian and transcerebellar approaches that minimize the division of neural tissue [6]. To the best of our knowledge this is the first case describing the TUF approach to exophytic cavernoma presenting in the lateral recess of the fourth ventricle. Under our institutional ethical review board regulations, approval was not necessary.

Asunto(s)

Cuarto Ventrículo; Hemangioma Cavernoso del Sistema Nervioso Central; Humanos; Masculino; Adulto; Cuarto Ventrículo/cirugía; Cuarto Ventrículo/diagnóstico por imagen; Hemangioma Cavernoso del Sistema Nervioso Central/cirugía; Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico por imagen; Procedimientos Neuroquirúrgicos/métodos; Neoplasias del Ventrículo Cerebral/cirugía; Neoplasias del Ventrículo Cerebral/diagnóstico por imagen; Craneotomía/métodos

Palabras clave

Cavernous malformation; Exophytic; Fourth ventricle; Lateral recess; Microsurgical anatomy; Tonsillouvular fissure approach

Texto completo

Añadir a Mi BVS

Imprimir

XML

PubMed Links

Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuarto Ventrículo / Hemangioma Cavernoso del Sistema Nervioso Central Límite: Adult / Humans / Male Idioma: En Revista: J Clin Neurosci Asunto de la revista: NEUROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo

Añadir a Mi BVS

Imprimir

XML

PubMed Links

Buscar en Google