phenylephrine-hydrochloride and Hemangioma--Cavernous--Central-Nervous-System

Brainstem lesions are challenging to manage, and surgical options have been controversial. Stereotactic radiosurgery (SRS) has been used for local control, but life-threatening toxicities from 0% to 9.5% have been reported. Several microsurgical approaches involving safe entry zones have been developed to optimize the exposure and minimize complications in different portions of the brainstem, but require extensive drilling and manipulation of neurovascular structures. With recent advancements, the endoscopic endonasal approach (EEA) can provide direct visualization of ventral brainstem. No case has been reported of EEA to remove a brainstem metastasis.. We present an illustrative case of a 68-yr-old female with metastatic colon cancer who presented with 2.8 × 2.7 × 2.1 cm (7.9 cm3) heterogeneously enhancing, right ventral pontine lesion with extensive edema. She underwent endoscopic endonasal transclival approach, and gross total resection of the lesion was achieved.. The endoscopic approach may offer certain advantages for removal of ventral brainstem lesions, as it can provide direct visualization of important neurovascular structures, especially, if the lesion displaces the tracts and comes superficial to the pial surface.

Topics: Aged; Brain Stem Neoplasms; Female; Hemangioma, Cavernous, Central Nervous System; Humans; Neuroendoscopy; Nose; Pons

Brainstem cavernomas can present very challenging operative problems. Endoscopic endonasal approaches to these lesions in the mesencephalon and pons have been described. In this article the authors present the first case of a medullary cavernoma resected by an endoscopic transclival approach. A 26 year-old woman with a 1.5 cm medullary cavernoma presented with imbalance, swallowing difficulty, and right hemibody weakness. She was taken to the operating room for endoscopic endonasal transclival resection. Her pre-existing neurologic deficits worsened initially after surgery, but at three-month follow-up she had made a full neurologic recovery.

Topics: Adult; Brain Neoplasms; Brain Stem; Female; Hemangioma, Cavernous, Central Nervous System; Humans; Mesencephalon; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Pons

Brainstem cavernous malformations are challenging due to the critical anatomy and potential surgical risks. Anterolateral, lateral, and dorsal surgical approaches provide limited ventral exposure of the brainstem. The authors present a case of a midline ventral pontine cavernous malformation resected through an endoscopic endonasal transclival approach based on minimal brainstem transection, negligible cranial nerve manipulation, and a straightforward trajectory. Technical and reconstruction technique advances in endoscopic endonasal skull base surgery provide a direct, safe, and effective corridor to the brainstem.

Topics: Adult; Brain Neoplasms; Cranial Fossa, Posterior; Hemangioma, Cavernous, Central Nervous System; Humans; Male; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Neurosurgical Procedures; Nose; Pons