2025 Volume 53 Issue 2 Pages 108-113
The use of endoscopy in the treatment of brainstem cavernous malformations (BCMs) has been reported in a limited number of cases. Given its ability to provide a broad and bright field of view even in deep regions, endoscopy is considered effective for treating deep-seated lesions, such as BCMs, and has been actively utilized in our institute.
This study retrospectively reviewed 32 cases of BCMs treated with endoscopic techniques (midbrain, 7 cases; pons, 22 cases; and medulla, 3 cases). The approach routes to the brainstem were based on the “Two Point Method,” primarily utilizing the nearby safe entry zones. Surgical removal was performed through transnasal procedures in 5 cases and craniotomy in 27 cases, with 25 of these employing small diameter cylinders to secure the surgical corridor. Gross total resection was achieved in 30 cases (93.8%). Postoperative complications were observed in five cases. The average Karnofsky Performance Status improved from 62.2 preoperatively to 84.4 3 months postoperatively, with improvements in 26 cases, no change in 5 cases, and deterioration in 1 case. Surgical treatments for BCMs are predominantly performed under a microscope; however, the outcomes of endoscopic surgery in this study showed favorable neurological prognoses compared with the findings of previous reports. The use of endoscopy facilitated the minimization of surgical pathways and enabled underwater surgery, thereby establishing a novel approach that is not preferably available in microscopic surgery. Underwater intraoperative observation, a distinctive feature of endoscopic surgery, was highly effective in identifying residual lesions and achieving hemostasis. Despite its advantages, endoscopy presents challenges, prompting ongoing developments and improvements in surgical instruments and techniques. Although this technique is still evolving, the utility of endoscopy for treating BCMs is promising.
