"Kissing" Brainstem Cavernous Angiomas Removed Using a Trans-Fourth Ventricular Floor Approach
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概要
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A 39-year-old woman presented with a rare case of “kissing” brainstem cavernomas formed by separate lesions enlarging with simultaneous recurrent hemorrhages, which was successfully treated by staged resection using a trans-fourth ventricular floor approach. She had a familial history of cerebral cavernous angioma, and presented with a history of four episodes of sudden neurological deterioration. Magnetic resonance (MR) imaging obtained at each neurological event demonstrated two distinct brainstem cavernomas located in the pontine tegmentum and ventral part of the lower pons, both of which enlarged stepwise caused by simultaneous recurrent hemorrhages. Both cavernomas contacted and formed “kissing” lesions. She underwent midline suboccipital craniotomy in the prone position. The cavernoma in the pontine tegmentum was resected through a trans-fourth ventricular floor approach. Although “kissing” formation appeared on preoperative MR imaging, parenchyma was identified at the bottom of the removal cavity of the dorsal lesion, and resection was terminated. MR imaging following the first surgery revealed complete resection of the pontine tegmentum cavernoma and the ventral pontine cavernoma, which was located adjacent to the bottom of the removal cavity and aligned in same direction along the fourth ventricular floor approach. At 10 days after first surgery, she underwent the same procedure with the aid of neuronavigation to resect the ventral pontine cavernoma through the former removal cavity. This approach through the previous removal route, particularly for resection of “kissing” lesions which are difficult to access in the brainstem, is a technically feasible microsurgical procedure.
- 社団法人 日本脳神経外科学会の論文
- 2011-10-15
著者
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ITO Kiyoshi
Department of Neurosurgery, Shinshu University School of Medicine
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MIYAHARA Takahiro
Department of Neurosurgery, Shinshu University School of Medicine
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HONGO Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine
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SAKAI Keiichi
Department of Neurosurgery, Shinshu University School of Medicine
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Hongo Kazuhiro
Department Of Neurosurgery Shinshu University School Of Medicine
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Hongo Kazuhiro
Department Of Mechanical Engineering School Of Systems Engineering National Defense Academy
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Miyahara Takahiro
Department Of Neurosurgery Shinshu University School Of Medicine
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Murata Takahiro
Department Of Bacteriology Shinshu University School Of Medicine
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Horiuchi Tetsuyoshi
Department Of Neurosurgery Shinshu University School Of Medicine
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Ito Kiyoshi
Department Of Neurosurgery Shinshu University School Of Medicine
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Muraoka Hisashi
Department Of Bioengineering Graduate School Of Engineering Osaka City University
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Sakai Keiichi
Department Of Neurosurgery Shinshu University School Of Medicine
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Ito Kiyoshi
Department Of Hematology/oncology The Institute Of Medical Science The University Of Tokyo
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Goto Tetsuya
Department Of Neurosurgery Shinshu University School Of Medicine
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HANAOKA Yoshiki
Department of Neurosurgery, Shinshu University School of Medicine
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Goto Tetsuya
Department Of Cardiovascular Surgery National Tokyo Medical Center
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Hanaoka Yoshiki
Department Of Neurosurgery Shinshu University School Of Medicine
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Muraoka Hisashi
Department Of Neurosurgery Shinshu University School Of Medicine
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Murata Takahiro
Department Of Neurosurgery Shinshu University School Of Medicine
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Ito Kiyoshi
Department of Gynecology, Tohoku University Graduate School of Medicine
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