Trans-cerebellomedullary fissure microsurgical resection of a middle cerebellar peduncle cavernous malformation: 2-Dimentional surgical video

Abstract

Background: The surgical treatment of cavernous malformation (CM) in the middle cerebellar peduncle is often very challenging due to its anatomical difficulties and the potential surgical risks. We successfully performed the removal of left middle cerebellar peduncle CM with a developmental venous anomaly (DVA) applying the cerebellomedullary fissure (CMF) approach, and herein we will discuss the outline of this experience and our surgical procedure accompanied by a surgical video. Case description: A 76 year old man was transferred to our hospital with a left cerebellar ataxia. He had a history of at least 3 episodes of CM hemorrhage in the past 2 years, and the preoperative image showed a left middle cerebellar peduncle hemorrhage just beside the fourth ventricle. Angiography showed the association of a DVA. Considering the location of the CM, we considered CMF approach to be the most effective procedure to achieve the removal of the CM without incising any normal brain structures. By completely opening the CMF up to the lateral recess of the fourth ventricle and incising the telovelar junction, we could realize a sufficient surgical corridor and maneuverability for the middle cerebellar peduncle lesion without any hindering and darkening of the microscopic view. Postoperative images showed the complete resection of the CM and the DVA remained intact. Conclusion: This report introduced the actual surgical procedure for the treatment of middle cerebellar peduncle CM with the CMF approach. The surgical videos provided here will help you understand the step-by-step surgical procedures required and the actual maneuverability for this approach.

Keywords

• Cavernous malformation
• Cerebellomedullary fissure approach
• Middle cerebellar peduncle
• Brainstem