Resection of Quadrigeminal Midbrain Cavernous Malformation Using the Supracollicular Safe Entry Zone

Authors

Christopher S. Graffeo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

Brainstem cavernous malformations (BSCMs) are rare and challenging neurosurgical lesions that demand a sophisticated and nuanced strategy for resection. A key element of surgical planning for BSCM resection is brainstem safe entry zones, a set of neuroanatomically defined locations where a pial resection can be executed with minimal risk to the adjacent central nervous system tracts and nuclei. Quadrigeminal BSCMs are particularly unusual and can be accessed via the supra-, inter-, or infracollicular safe entry zones. We report a unique demonstration of the supracollicular safe entry zone for the resection of a symptomatic hemorrhagic quadrigeminal plate BSCM. A man in his early 60s presented with transient hearing loss and visual dysfunction. A right quadrigeminal midbrain cavernous malformation was identified on magnetic resonance imaging. Surgical resection was performed with the patient in the sitting position. A bipedicular suboccipital flap, torcular craniotomy, and midline supracerebellar infratentorial approach were used. The lesion itself was accessed via the supracollicular safe entry zone, where pial hemosiderin staining was also encountered, using a linear transverse incision just above the right superior colliculus. Gross total resection was achieved, and the patient recovered from surgery with no new neurologic deficits (Video 1).

Medical Subject Headings

Male; Humans; Neurosurgical Procedures (methods); Hemangioma, Cavernous, Central Nervous System (diagnostic imaging, surgery, pathology); Mesencephalon (diagnostic imaging, surgery, pathology); Brain Stem (surgery); Craniotomy (methods)

Publication Date

1-1-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

169

First Page

51

PubMed ID

36334709

Digital Object Identifier (DOI)

10.1016/j.wneu.2022.10.111

Recommended Citation

Graffeo, Christopher S.; Scherschinski, Lea; Baranoski, Jacob F.; Srinivasan, Visish M.; and Lawton, Michael T., "Resection of Quadrigeminal Midbrain Cavernous Malformation Using the Supracollicular Safe Entry Zone" (2023). Neurosurgery. 1832.
https://scholar.barrowneuro.org/neurosurgery/1832