C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E7-E7
Author(s):  
Alejandro Enriquez-Marulanda ◽  
Abdulrahman Y Alturki ◽  
Kimberly Kicielinski ◽  
Ajith J Thomas ◽  
Christopher S Ogilvy
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Lower Limbs ◽  
Motor Deficits ◽  
Cavernous Malformations ◽  
Neurophysiologic Monitoring ◽  
Left Limb ◽  
Patient Consent ◽  
Microsurgical Resection

Abstract We describe the case of a previously healthy 44-yr-old female patient presenting with a sudden onset of numbness, paresthesias, and decreased sensation in her lower limbs. Physical examination revealed a decreased sensation to vibration and light touch in her lower extremities, primarily in the left limb. Impaired proprioception was also evident primarily in the left toe. Full strength with 2+ reflexes was observed in all extremities. Magnetic resonance imaging demonstrated an exophytic lesion in the posterior aspect of the cervical spinal cord at the C5-C6 level, with a hemosiderin halo, consistent with a cavernous malformation. Given the evidence of past hemorrhage and the location of the lesion, microsurgical intervention was indicated. A midline cervical C5-C6 laminectomy under neurophysiologic monitoring was performed, and complete resection of the lesion was achieved with mild improvement of the sensitive symptoms and no evidence of new motor deficits. Any microsurgical resection of a cervical spinal cord lesion can be technically difficult and adequate patient selection with evaluation of the accessibility to the lesion is key.1 Surgical resection of cavernous malformations in selected patients eliminates the risk of future hemorrhage and may achieve satisfactory outcomes comparable to patients who undergo conservative management.2 In the following video illustration, we narrate this operative case, and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

scholarly journals Microsurgical resection of symptomatic intramedullary cervical spinal cord cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V12
Author(s):  
Tomasz A. Dziedzic ◽  
Andrzej Marchel
Keyword(s):  
Spinal Cord ◽  
Postoperative Morbidity ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Significant Risk ◽  
Neural Tissue ◽  
Complete Resection ◽  
Surgical Removal ◽  
Cavernous Malformations ◽  
Microsurgical Resection

Intramedullary cavernous malformations account for approximately 5% of all intraspinal lesions. Symptomatic lesions are treated with microsurgical resection. Due to surrounding eloquent spinal neural tissue, surgical removal of these lesions can be technically challenging. Surgical treatment carries a significant risk for postoperative morbidity. This video demonstrates the main steps for the microsurgical technique of resection of a symptomatic intramedullary cervical spinal cord cavernous malformation at the C2–3 level. Complete resection was achieved with minimal posterior column deficit. The operative technique and surgical nuances, including the patient’s positioning, surgical approach, intraspinal cavernous malformation removal, and closure, are illustrated.The video can be found here: https://youtu.be/UKttTiXlEb8.

Endoscopic Paramedian Sitting Craniotomy for Resection of a Dorsal Midbrain Cavernous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E300-E300
Author(s):  
Omar A Choudhri ◽  
Gregory Glauser ◽  
Kalil G Abdullah ◽  
John Y K Lee
Keyword(s):  
Cavernous Malformation ◽  
University Of Pennsylvania ◽  
Neurophysiologic Monitoring ◽  
Institutional Review ◽  
Patient Consent ◽  
Stereotactic Navigation ◽  
Microsurgical Resection ◽  
The Right ◽  
The University

Abstract This case video demonstrates the surgical technique for resection of a cavernous malformation in the right dorsal midbrain. This video was deemed exempt by the University of Pennsylvania Institutional Review Board (IRB), as it is considered a case report, which does not require IRB approval or patient consent. The patient was a 57-yr-old male with cerebral cavernous malformation syndrome with multiple intracranial cavernomas. He was noticed to have progressively slowed speech with worsening confusion and drowsiness. On exam, the patient exhibited worsening in swallowing and upward gaze paresis, secondary to Parinaud phenomena. The patient was treated with microsurgical resection, utilizing stereotactic navigation and intraoperative neurophysiologic monitoring. Intraoperative view provided in the video was captured using a Karl Storz Endoscope (Karl Storz SE & Co KG, Tuttlingen, Germany). Postoperatively, the patient had worsening double vision, which improved on follow-up, in addition to improvement in sensorium and swallowing.

Microsurgical resection of intramedullary spinal cord cavernous malformation. Operative video and technical nuances

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video1
Author(s):  
James K. Liu
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Significant Risk ◽  
Complete Resection ◽  
Definitive Treatment ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Spinal Stabilization ◽  
Progressive Myelopathy ◽  
Microsurgical Resection

Intramedullary spinal cord cavernous malformations account for approximately 5% of all intraspinal lesions. These lesions can present with either acute neurological compromise secondary to hemorrhage inside the spinal cord, or with chronic progressive myelopathy due to repeated microhemorrhages. Surgical resection of spinal cord cavernous malformations remains the definitive treatment strategy for symptomatic lesions. Because of the intimate relationship with surrounding eloquent neural tissue, these lesions can be technically challenging to remove with a significant risk for morbidity. In this operative video, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a large intramedullary spinal cord cavernous malformation at C4–5 causing progressive myelopathy. Complete resection was achieved without neurologic compromise. The operative technique and surgical nuances, including the surgical approach, intradural cavernoma removal, and spinal stabilization are illustrated.The video can be found here: http://youtu.be/3FUjGSyrKO0.

scholarly journals Giant Cervical Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E153-E153
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Video Recording ◽  
Gross Total Resection ◽  
Cervical Cord ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Institutional Review ◽  
High Cervical

Abstract Cervical spinal cord cavernous malformations are rare but can be neurologically devastating lesions and, when symptomatic, are best treated with gross total resection to prevent progressive neurologic decline related to recurrent hemorrhage. This patient had a large high cervical cord cavernous malformation with evidence of recent hemorrhage. A midline myelotomy was utilized to enter the cavernous malformation. The cavernous malformation was then circumferentially separated from the spinal parenchyma and removed in a piecemeal manner. Postoperative imaging confirmed gross total resection of the lesion with preservation of the surrounding spinal cord. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Intramedullary Cavernous Malformation of the Spinal Cord in Two Dogs

2007 ◽  
Vol 44 (4) ◽  
pp. 528-532 ◽  
Author(s):  
E. MacKillop ◽  
N. J. Olby ◽  
K. E. Linder ◽  
T. T. Brown
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Postmortem Examination ◽  
Spinal Cord Lesion ◽  
Intraparenchymal Hemorrhage ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Vascular Channels ◽  
Thin Walled ◽  
Cord Lesion

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.

Resection of a ventral intramedullary cervical spinal cord cavernous malformation through an anterior approach

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video18 ◽  
Author(s):  
Alexander G. Weil ◽  
Sanjiv Bhatia
Keyword(s):  
Spinal Cord ◽  
Surgical Approach ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Pediatric Population ◽  
Complete Resection ◽  
Surgical Access ◽  
Partial Corpectomy

Ventrally-located intramedullary cervical spinal cord cavernomas are rare entities in the pediatric population. Surgical access to these lesions is challenging. The authors present the complete resection of a symptomatic ventral cervical intramedullary cavernoma through an anterior approach in a 15-year-old boy. The lesion was accessed following left anterolateral dissection, C3–4 discectomy and C3/C4 partial corpectomy. The authors will discuss the rationale for intervening in this patient and for selecting this anterior approach over other approaches, such as the anterolateral, posterolateral or posterior approach. The steps, pitfalls and pearls of this surgical approach will be demonstrated in a detailed video.The video can be found here: http://youtu.be/-ARTp6g13hgs.

scholarly journals Neuromyelitis Optica in a Nepalese Man

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yogesh Subedi ◽  
Utsav Joshi ◽  
Sanjeeb Sudarshan Bhandari ◽  
Ashbina Pokharel ◽  
Ashbita Pokharel
Keyword(s):  
Spinal Cord ◽  
Neuromyelitis Optica ◽  
Immunoglobulin G ◽  
Cervical Spinal Cord ◽  
Immunosuppressive Treatment ◽  
Lower Limbs ◽  
Inflammatory Disorder ◽  
Hyperintense Signal ◽  
Muscle Groups ◽  
The Right

Background. Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. Here, we present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. Case Presentation. A 46-year-old Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. Magnetic resonance imaging of his cervical spine showed T1 iso- to hypointense signal and T2 hyperintense signal in central cervical spinal cord from first to sixth cervical level, probably suggestive of myelitis or demyelination. The patient was immediately started on intravenous methylprednisolone. The diagnosis of neuromyelitis optica was later confirmed with strongly positive neuromyelitis optica immunoglobulin G. Conclusion. In resource limited setting, in the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient’s condition started to get better. Hence, early initiation of aggressive immunosuppressive treatment is essential in such cases.

Intraoperative MR imaging in a case of a cervical spinal cord lesion

2011 ◽  
Vol 14 (6) ◽  
pp. 754-757 ◽  
Author(s):  
David Netuka ◽  
Svatopluk Ostrý ◽  
Tomáš Belšán ◽  
Filip Kramář ◽  
Vladimír Beneš
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Cervical Pain ◽  
Neck Flexion ◽  
Before And After ◽  
Cord Lesion

The aim of this article is to describe the feasibility of performing intraoperative MR imaging in patients with spinal cord lesions and the potential value of this technique. The authors report a case involving a 28-year-old man who presented with chronic cervical pain and pain along the ulnar side of the forearms during neck flexion. Findings on clinical examination were normal, but MR imaging revealed a multicystic cervical spinal cord lesion. Surgery was undertaken to open the cysts, evacuate old blood, and search for pathological tissue. Intraoperative MR imaging showed that the caudal cyst was not opened, and surgery was therefore continued. The caudal cyst was fenestrated and a suspected small cavernous malformation was removed. Electrophysiological monitoring was performed both before and after the intraoperative MR imaging. The use of intraoperative MR imaging changed the strategy of the procedure and helped the surgeon to safely enter all the cysts in the cervical cord.

scholarly journals Microsurgical resection of an inferior cerebellar peduncle cavernous malformation: 3-Dimensional operative video

2019 ◽  
Vol 1 (1) ◽  
pp. V22
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Julia Goginski ◽  
Pedro H. A. da Silva ◽  
Gabriel S. de Fraga ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Neurophysiological Monitoring ◽  
Cavernous Malformations ◽  
3 Dimensional ◽  
Initial Symptoms ◽  
Intimate Relation ◽  
Microsurgical Resection ◽  
Cerebellomedullary Fissure ◽  
Cerebellar Peduncle ◽  
Inferior Cerebellar Peduncle

Brainstem cavernous malformations are especially difficult to treat because of their deep location and intimate relation with eloquent structures. This is the case of a 26-year-old female presenting with dizziness, dysmetria, nystagmus and unbalance. Imaging depicted a lesion highly suggestive of a cavernous malformation in the left inferior cerebellar peduncle. Following a suboccipital midline craniotomy, the cerebellomedullary fissure was dissected and the lesion was identified bulging the surface. The malformation was completely removed with constant intraoperative neurophysiological monitoring. The patient presented improvement of initial symptoms with no new deficits. Surgical resection of brainstem cavernous malformations can be successfully performed, especially when superficial, using the inferior cerebellar peduncle as an entry zone.The video can be found here: https://youtu.be/-GGZe_CaZnQ.

Lateral Myelotomy for Resection of a Ruptured Intramedullary Cervico-Thoracic Cavernous Malformation

2020 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Yehuda Herschman ◽  
Nitesh V Patel ◽  
Fareed Jumah ◽  
Zhenggang Xiong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Lateral Approach ◽  
Sudden Onset ◽  
Sensory Loss ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Motor Weakness ◽  
Left Lower Extremity ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Intramedullary spinal cord cavernous malformations represent 5% to 12% of spinal vascular disease. Most patients present with acute or progressive neurological symptoms, including motor weakness or sensory loss. Surgical resection is the only definitive management and is recommended for symptomatic lesions that are surgically accessible. CLINICAL PRESENTATION A 35-yr-old woman presented with a sudden onset of pain and temperature sensation loss in the left lower extremity. Magnetic resonance imaging of the spine showed a hemorrhage located ventral and slightly lateral to the right of the midline of the spinal cord from C7 through T3. Ultimately, a right lateral myelotomy between the ventral and dorsal roots was performed, and the cavernous malformation was removed. Postoperative imaging confirmed gross total resection of the cavernous malformation. CONCLUSION In this article, we report a highly unusual case of a multisegment, ruptured intramedullary cavernous malformation that was ultimately resected through a lateral myelotomy approach. This case demonstrates that a lateral approach to the spinal cord substance can be utilized for ruptured cavernous malformation, especially if there is hemorrhage at the surface of the spinal cord. This can be used as an entry into the anterolateral compartment of the spinal cord, which would otherwise be regarded as a highly morbid approach due to the sensory deficits induced. We believe this entry point to the spinal cord is feasible in highly select cases such as this.

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