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| Name | Lateral Supracerebellar Infratentorial Craniotomy for Resection of Ruptured Cavernous Malformation |
| Video Uploader | Video From Barrow Neurological Institute |
| Upload Date | This Video Uploaded At 14-04-2020 18:04:36 |
| Video Discription | This video shows a lateral supracerebellar infratentorial craniotomy for resection of a pontomesencephalic cavernous malformation with a history of three prior hemorrhages. The patient presented with mild weakness and sensory disturbance bilaterally. Axial and sagittal MR images demonstrated a lesion located in the inferior part of the midbrain and extending down to the upper part of the pons. Given the low location of the lesion, access was more difficult than a traditional upper-midbrain exposure. We therefore decided to use a sitting approach to allow the cerebellum to sag and the corresponding approach to drop lower in this region. The key anatomic landmarks for this approach are the trochlear nerve (CN IV) and superior cerebellar artery in the ambient and quadrigeminal cisterns. The cavernous malformation was just below the surface of the posterolateral midbrain and was exposed using spreading dissection. The capsule was freed of adhesions with the surrounding midbrain using an angled round dissecting knife. The cavity was explored visually postresection to confirm clear tissue margins around the resection bed. The patient did well after surgery and had no complications. Postoperative MRI confirmed no residual cavernous malformation was present. Treatment is indicated in patients with brainstem cavernous malformation and multiple symptomatic hemorrhages. Resection of these difficult-to-approach lesions can be facilitated by using the sitting position and gravity-assisted retraction of the cerebellum to access the supracerebellar plane. This is especially advantageous when the lesion extends below the level of the ambient cistern. The trochlear nerve can be mobilized to access the safe entry zone. |
| Category | Science & Technology |
| Tags | cavernous malformation | midbrain cavernous malformation | pontomesencephalic cavernous malformation | lateral supracerebellar infratentorial approach | ruptured cavernous malformation | cavernous malformation resection | cerebrovascular surgery | cavernous malformation surgery | neurosurgery | neurosurgery video |
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