Contralateral supracerebellar-infratentorial approach for resection of thalamic cavernous malformations
Document Type
Article
Abstract
BACKGROUND: Surgical resection of cavernous malformations (CM) in the posterior thalamus, pineal region, and midbrain tectum is technically challenging owing to the presence of adjacent eloquent cortex and critical neurovascular structures. Various supracerebellar infratentorial (SCIT) approaches have been used in the surgical armamentarium targeting lesions in this region, including the median, paramedian, and extreme lateral variants. Surgical view of a posterior thalamic CM from the traditional ipsilateral vantage point may be obscured by occipital lobe and tentorium. OBJECTIVE: To describe a novel surgical approach via a contralateral SCIT (cSCIT) trajectory for resecting posterior thalamic CMs. METHODS: From 1997 to 2017, 75 patients underwent the SCIT approach for cerebrovascular/oncologic pathology by the senior author. Of these, 30 patients underwent the SCIT approach for CM resection, and 3 patients underwent the cSCIT approach. Historical patient data, radiographic features, surgical technique, and postoperative neurological outcomes were evaluated in each patient. RESULTS: All 3 patients presented with symptomatic CMs within the right posterior thalamus with radiographic evidence of hemorrhage. All surgeries were performed in the sitting position. There were no intraoperative complications. Neuroimaging demonstrated complete CM resection in all cases. There were no new or worsening neurological deficits or evidence of rebleeding/recurrence noted postoperatively. CONCLUSION: This study establishes the surgical feasibility of a contralateral SCIT approach in resection of symptomatic thalamic CMs It demonstrates the application for this procedure in extending the surgical trajectory superiorly and laterally and maximizing safe resectability of these deep CMs with gravity-assisted brain retraction.
Publication Date
10-1-2018
Publication Title
Operative Neurosurgery
ISSN
23324252
E-ISSN
23324260
Volume
15
Issue
4
First Page
404
Last Page
411
PubMed ID
29490051
Digital Object Identifier (DOI)
10.1093/ons/opy004
Recommended Citation
Mascitelli, Justin; Burkhardt, Jan Karl; Gandhi, Sirin; and Lawton, Michael T., "Contralateral supracerebellar-infratentorial approach for resection of thalamic cavernous malformations" (2018). Neurosurgery. 1258.
https://scholar.barrowneuro.org/neurosurgery/1258