title: Custom-tailored minimally invasive partial C2-corpectomy for ventrally located intramedullary cavernous malformation.
abstract: Approaches to ventrally located intramedullary lesions of the upper cervical spine can be extremely challenging. We present a custom-tailored, minimally invasive anterior approach to a ventrally located, intramedullary cavernous hemangioma with partial lateral corpectomy of C2, complete resection of the lesion and subsequent reconstruction. A 20-year-old woman presented with the history of progressive numbness of the left upper and lower extremities and some episodes of severe headaches was referred to magnetic resonance imaging: Here, an intramedullary lesion with typical radiological features for a cavernous malformation at the ventral surface of the spinal cord at the C2 level was detected. The surgical procedure was performed under general anesthesia and electrophysiological monitoring (somatosensory-evoked potentials (SEP), muscle motor-evoked potentials (MEP), and D-wave recording). Complete resection of the cavernous malformation was achieved and reconstruction of the cervical spine was performed using a custom-tailored cage. Intraoperative neuromonitoring during resection, revealed a transient MEP loss, but unchanged D-wave and SEP recordings indicated unchanged neurological outcome. Early clinical follow-up of the patient revealed no new neurological deficits. At 3-month follow-up, there was some improvement of the sensory function. This custom-tailored minimally invasive anterior approach to a ventrally located intramedullary cavernous malformation with partial C2-corpectomy describes a possible and successful approach to ventrally located intramedullary lesions of the upper cervical spinal cord. Additionally, the hereby-described approach is not related to cervical instability.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. eicker.s@mac.com
authors.forename: Sven O
authors.initials: SO
authors.lastname: Eicker
authors.forename: Sve O
authors.initials: SO
authors.lastname: Eicker
authors.forename: Andrea
authors.initials: A
authors.lastname: Szelényi
authors.forename: Christian
authors.initials: C
authors.lastname: Mathys
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
mesh_terms: D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000601:surgery*; D046748:Hematoma, Epidural, Spinal / Q000209:etiology / Q000473:pathology; D006801:Humans; D017846:Longitudinal Ligaments / Q000601:surgery; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008991:Monitoring, Physiologic; D019635:Neurosurgical Procedures / Q000379:methods*; D013131:Spine / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult