CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 05): S420-S421
DOI: 10.1055/s-0038-1669974
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Retrosigmoid Approach for Resection of Cerebellar Peduncle Cavernoma

Hussam Abou-Al-Shaar
1  Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Gmaan Alzhrani
1  Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Yair M. Gozal
1  Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
William T. Couldwell
1  Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Address for correspondence

William T. Couldwell, MD, PhD
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah
175 North Medical Drive East, Salt Lake City, UT 84132
United States   

Publication History

21 May 2018

12 August 2018

Publication Date:
25 September 2018 (eFirst)

 

    Abstract

    The case described in this video involved a 38-year-old man, who presented with a 4-week history of worsening acute-onset headache, nausea, double vision, and vertigo. On examination, he had impaired tandem gait and diplopia on right horizontal gaze. A computed tomography (CT) scan revealed a hyperdense lesion of the right cerebellopontine angle. Magnetic resonance imaging (MRI) revealed a nonenhancing middle cerebellar peduncle lesion that was isointense on T2-weighed imaging and hypointense on FLAIR imaging ([Fig. 1A]–[B]). The differential diagnoses for this lesion included cavernous malformation, thrombosed aneurysm, and neurocysticercosis. CT angiography was done preoperatively to rule out cerebral aneurysm. Surgical resection of the lesion was recommended to relieve his symptoms, to prevent further deterioration/bleeding, and to obtain a pathological diagnosis. The patient underwent a right retrosigmoid craniotomy for resection of the right middle cerebellar peduncle cavernoma ([Fig. 2]). The patient tolerated the procedure well with no new postoperative neurological deficit. Postoperative MRI depicted gross total resection of the lesion and expected residual blood in the resection cavity ([Fig. 1C]–[D]). The patient was discharged home on postoperative day 4. At his last follow-up appointment, 1 month after surgery, he reported complete resolution of his preoperative symptoms, including diplopia. The patient gave consent for publication.

    The link to the video can be found at: https://youtu.be/TRieS9DXbV4.


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    Zoom Image
    Fig. 1 (AB) Preoperative magnetic resonance images showing cerebellar peduncle lesion. The lesion was: (A) isointense on axial T2-weighted imaging, and (B) hypointense on sagittal FLAIR imaging. (C–D) Postoperative axial T2-weighted and sagittal T1-weighted magnetic resonance images showing gross total removal of the lesion with some residual blood in the surgical cavity.
    Zoom Image
    Fig. 2 Intraoperative image demonstrating resection of the hemosiderin-stained cavernoma.

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    Quality:

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    Conflict of Interest

    None.

    Acknowledgments

    We thank Vance Mortimer for assistance with the video and Kristin Kraus for editorial assistance.


    Address for correspondence

    William T. Couldwell, MD, PhD
    Department of Neurosurgery, Clinical Neurosciences Center, University of Utah
    175 North Medical Drive East, Salt Lake City, UT 84132
    United States   


      
    Zoom Image
    Fig. 1 (AB) Preoperative magnetic resonance images showing cerebellar peduncle lesion. The lesion was: (A) isointense on axial T2-weighted imaging, and (B) hypointense on sagittal FLAIR imaging. (C–D) Postoperative axial T2-weighted and sagittal T1-weighted magnetic resonance images showing gross total removal of the lesion with some residual blood in the surgical cavity.
    Zoom Image
    Fig. 2 Intraoperative image demonstrating resection of the hemosiderin-stained cavernoma.