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Extended middle fossa approach to lateralized pontine cavernomas in children.
Rennert, Robert C; Hoshide, Reid; Calayag, Mark; Kemp, Joanna; Gonda, David D; Meltzer, Hal S; Fukushima, Takanori; Day, John D; Levy, Michael L.
Afiliação
  • Rennert RC; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Hoshide R; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Calayag M; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Kemp J; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Gonda DD; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Meltzer HS; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
  • Fukushima T; 2Carolina Neuroscience Institute, Raleigh, North Carolina; and.
  • Day JD; 3Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas.
  • Levy ML; 1Department of Pediatric Neurosurgery, University of California, San Diego, California.
J Neurosurg Pediatr ; 21(4): 384-388, 2018 04.
Article em En | MEDLINE | ID: mdl-29393814
ABSTRACT
OBJECTIVE Treatment of hemorrhagic cavernous malformations within the lateral pontine region demands meticulous surgical planning and execution to maximize resection while minimizing morbidity. The authors report a single institution's experience using the extended middle fossa rhomboid approach for the safe resection of hemorrhagic cavernomas involving the lateral pons. METHODS A retrospective chart review was performed to identify and review the surgical outcomes of patients who underwent an extended middle fossa rhomboid approach for the resection of hemorrhagic cavernomas involving the lateral pons during a 10-year period at Rady Children's Hospital of San Diego. Surgical landmarks for this extradural approach were based on the Fukushima dual-fan model, which defines the rhomboid based on the following anatomical structures 1) the junction of the greater superficial petrosal nerve (GSPN) and mandibular branch of the trigeminal nerve; 2) the lateral edge of the porus trigeminus; 3) the intersection of the petrous ridge and arcuate eminence; and 4) the intersection of the GSPN, geniculate ganglion, and arcuate eminence. The boundaries of maximal bony removal for this approach are the clivus inferiorly below the inferior petrosal sinus; unroofing of the internal auditory canal posteriorly; skeletonizing the geniculate ganglion, GSPN, and internal carotid artery laterally; and drilling under the Gasserian ganglion anteriorly. This extradural petrosectomy allowed for an approach to all lesions from an area posterolateral to the basilar artery near its junction with cranial nerve (CN) VI, superior to the anterior inferior cerebellar artery and lateral to the origin of CN V. Retraction of the mandibular branch of the trigeminal nerve during this approach allowed avoidance of the region involving CN IV and the superior cerebellar artery. RESULTS Eight pediatric patients (4 girls and 4 boys, mean age of 13.2 ± 4.6 years) with hemorrhagic cavernomas involving the lateral pons and extension to the pial surface were treated using the surgical approach described above. Seven cavernomas were completely resected. In the eighth patient, a second peripheral lesion was not resected with the primary lesion. One patient had a transient CN VI palsy, and 2 patients had transient trigeminal hypesthesia/dysesthesia. One patient experienced a CSF leak that was successfully treated by oversewing the wound. CONCLUSIONS The extended middle fossa approach can be used for resection of lateral pontine hemorrhagic cavernomas with minimal morbidity in the pediatric population.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemangioma Cavernoso do Sistema Nervoso Central / Neoplasias do Tronco Encefálico / Fossa Craniana Média Tipo de estudo: Evaluation_studies / Observational_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemangioma Cavernoso do Sistema Nervoso Central / Neoplasias do Tronco Encefálico / Fossa Craniana Média Tipo de estudo: Evaluation_studies / Observational_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Ano de publicação: 2018 Tipo de documento: Article