Endoscopic Endonasal Transclival Resection of a Brainstem Cavernoma: A Detailed Account of Our Technique and Comparison with the Literature.
OBJECTIVE
To report a technique of endoscopic transclival resection of a hemorrhagic brainstem cavernous malformation manifesting in the ventral pons.


METHODS
A 29-year-old woman presented with numbness and tingling of the right arm and leg and loss of fine motor control. Magnetic resonance imaging revealed a cavernoma in the ventromedial brainstem on the ventral surface. A purely endoscopic, endonasal, transclival approach was used to resect this cavernoma. Computed tomography/magnetic resonance imaging merged navigation (StealthStation, Medtronic) was used.


RESULTS
The patient had no neurologic deficits postoperatively. The motor control loss and tingling disappeared. She did not experience any complications. Cerebrospinal fluid leakage appeared to result from using the very small opening of the skull base and dura mater and was the reason for the use of a lumbar drain for several days. At the 6-week follow-up examination, the patient was in excellent condition with no neurologic deficits and had returned to her full-time job.


CONCLUSIONS
Successful endoscopic, endonasal, transclival resection of a brainstem cavernous malformation was described. This patient experienced improvement in neurologic symptoms after surgery without morbidity. Technologic advances in endoscopic skull base approaches provide access to lesions of the brainstem that previously required more invasive approaches. The endonasal transclival approach provides the most direct route to ventral pontine lesions. Early intervention in brainstem cavernous malformation is indicated and should be performed with an individualized approach taking into consideration the possible complications.
Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany. Electronic address: stefan.linsler@uks.eu.
Stefan
S
Linsler
Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany.
Joachim
J
Oertel
D000328:Adult; D001933:Brain Stem / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D004569:Electroencephalography; D004724:Endoscopy / Q000379:methods*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000379:methods*; D011597:Psychomotor Performance; D020127:Recovery of Function; D016896:Treatment Outcome
Brain stem; Cavernous malformation; Endonasal; Endoscopy; Transclival