title: Long-Term Outcome of Endonasal Transsphenoidal Approach for the Treatment of Pontine Cavernous Malformation: Case Report with 11 Years of Follow-Up.
abstract: Ventromedial localized cavernous malformations in the pons pose a difficult problem because of their surgical access and the high risk of deleterious consequences due to damage of the surrounding tissues. We report an endonasal transsphenoidal approach for the treatment of ventromedial pontine cavernomas that also follows principles of optimal access known as the "two-point method" for the resection of cavernous malformations. A 31-year-old woman presented with sudden left hemiparesis, nausea, and headache. Radiologic findings demonstrated a ventral pontine cavernous malformation in the midline slightly extending to the right, together with signs of acute hemorrhage. Surgical intervention was performed, and the cavernoma was completely resected via a transnasal transsphenoidal approach. Cerebrospinal fluid (CSF) rhinorrhea that ensued postoperatively needed an additional reconstructive surgery using the same approach. No further CSF leakage was evident, and an 11-year follow-up examination revealed neither signs of neurologic deficit nor recurrence of the resected pontine cavernoma. The long-term outcome proves the effectiveness and safety of this novel surgical route in the treatment of ventromedial cavernous malformations in the pons.
authors.affiliation: Department of Neurosurgery, National Institute of Neurosurgery, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Banczerowski
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Czigléczki
authors.affiliation: Department of Otolaryngology, National Institute of Neurosurgery, Budapest, Hungary.
authors.forename: Ildikó
authors.initials: I
authors.lastname: Gádor
authors.affiliation: Department of Neurosurgery, National Institute of Neurosurgery, Budapest, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Nyáry
mesh_terms: D000328:Adult; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*; D011149:Pons / Q000000981:diagnostic imaging / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery*; D016896:Treatment Outcome