Artikel
Transcerebellomedullary fissure approach for the treatment of brainstem cavernomas
Der transzerebellomeduläre Zugang für die Behandlung von Hirnstammkavernomen
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Autoren
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L. Benes
- Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
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T. Mikami
- Sapporo Medical University, School of Medicine, Japan
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U. Sure
- Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
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C. Kappus
- Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
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T. Dukatz
- Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
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D. Miller
- Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
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H. Bertalanffy
- Klinik für Neurochirurgie, Universitätsspital Zürich, Schweiz
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: There is no detailed description of the transcerebellomedullary fissure approach (TCMFA) as a surgical corridor for the resection of brainstem cavernomas in the pertinent literature. The purpose of this study was to analyze this specific approach for the resection of brainstem cavernomas in our consecutively treated patients.
Methods: Out of a total of 93 brainstem cavernoma patients surgically treated in a 9-year-period (1997-2006), a retrospective chart review and video analysis was performed in 30 patients operated via the TCMFA. The microsurgical strategy was to localize the cavernomas in the brainstem and to circularly dissect the lesion by interrupting the tiny vessels entering the lesion. Surgery was assisted by somatosensory evoked potentials, cranial nerve monitoring and neuronavigation. Long-term follow-up (mean 25.8 months) included a neurological examination and magnetic resonance (MR) imaging studies. Statistical analyses were performed with chi-square test and Mann-Whitney U-test for independence (p<0.05 was considered statistically significant).
Results: Eighteen males and twelve females (mean age 41.5 yrs) with brainstem cavernomas could be diagnosed. Five individuals suffered from an exophytic and 25 from intrinsic lesions. A paramedian incision was performed in 14 patients, a median incision in 8 and either a lateral or inferior incision in 4 individuals, respectively. Total removal was achieved in all patients documented in the follow-up MRI. In 19 individuals (82.6%) the neurological status (long-term follow-up was available in 23 of 30 patients) improved after surgery or clinical features were unchanged. Two patients died due to sepsis and liver failure, respectively.
Conclusions: The TCMFA provides an excellent exposure of brainstem cavernomas adjacent to the rhomboid fossa. Total removal of these lesions assisted by intraoperative neuromonitoring and navigaion can be managed with a satisfying procedure-related morbidity via the TCMFA. Prior to surgery a meticulous evaluation of indication, surgical approach and entry zone is essential.
