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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Transcerebellomedullary fissure approach for the treatment of brainstem cavernomas

Der transzerebellomeduläre Zugang für die Behandlung von Hirnstammkavernomen

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  • corresponding author L. Benes - Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
  • T. Mikami - Sapporo Medical University, School of Medicine, Japan
  • U. Sure - Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
  • C. Kappus - Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
  • T. Dukatz - Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
  • D. Miller - Klinik für Neurochirurgie, Philipps-Universität Marburg, Germany
  • H. Bertalanffy - Klinik für Neurochirurgie, Universitätsspital Zürich, Schweiz

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.08.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc252.shtml

Published: May 30, 2008

© 2008 Benes et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.