2016 Volume 26 Issue 3 Pages 216-223
Brain stem cavernous malformations (BSCMs) are associated with a high rate of hemorrhagic events. Though BSCMs that bleed or grow in size are indicated for resection, the surgical procedure usually involves a high risk of damage to the normal brain. We successfully achieved total resection, in two cases of symptomatic BSCMs, using a neuroendoscope. The BSCM was localized in the ventral part of the pons in the first case and in the middle cerebellar peduncle in the second case. In both cases, diffusion tensor images (DTI) were taken with an MRI to confirm the localization of the BSCM in relation to the pyramidal tracts. We resected the BSCMs using a ‘wet field method’ which renders the surgical fields clear without using suction tubes. The wet field provides the operator with an increased range of manipulation even in a tight space.
With our technique, the indications of endoscopic surgery have widened. We have shown that neuroendoscopic surgery can safely and effectively replace conventional craniotomy for certain brain stem lesions.
