gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Petrosal bone reconstruction for treatment of kinetic tremor due to cerebellar herniation and torsion of cerebellar outflow pathways

Rekonstruktion des Felsenbeins zur Behandlung eines kinetischen Tremors nach zerebellärer Herniation und Torsion der efferenten zerebellären Bahnen

Meeting Abstract

  • O. Sedlaczek - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • C. Blahak - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • E. Grips - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • W. Bergler - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • W. Neff - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • M. Hennerici - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • M. Daffertshoffer - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim
  • corresponding author Joachim K. Krauss - Neurochirurgische Klinik, Neurologische Klinik, HNO und Radiologische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 09.94

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0377.shtml

Published: April 23, 2004

© 2004 Sedlaczek et al.
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Outline

Text

Objective

Kinetic tremor due to lesions of the cerebellum and the cerebellothalamic pathways are a therapeutic challenge. There are no treatment options usually to repair the primary structural deficit. This is the first study to report causal treatment of kinetic tremor taking into account preoperative functional imaging.

Methods

Videographic and both structural and functional imaging studies were performed in a 42-year-old man, who was referred with right-sided kinetic tremor. Six months earlier, a glomus jugulare tumor was removed via a right petrosectomy. At the time of the referral, the patient also suffered from gait ataxia, dysarthria, nystagmus and a peripheral facial palsy.

Results

MRI studies revealed a herniation of the right cerebellum into the bony deficit after the petrosectomy, accompanied by torsion of the cerebellar outfow pathways. Functional MRI demonstrated the herniated cerebellar tissue to be functionally intact. Transfemoral angiography showed no obstruction of blood flow in the superior cerebellar artery. The patient then underwent a lateral suboccipital craniotomy with reposition of the herniation and plastic reconstruction of the petrosal bone. Apart from the facial palsy, the deficits improved within days, and the tremor disappeared almost completely.

Conclusions

Functional imaging is useful in decision-making to plan surgical repair after petrosectomy. In rare cases, kinetic tremor can be cured by reconstruction of the posterior fossa.