TY - JOUR
T1 - Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation
T2 - anatomical and tractography study of the surgical approach and functional implications
AU - Brogna, Christian
AU - Lavrador, José Pedro
AU - Kandeel, Hussein Shaaban
AU - Beyh, Ahmad
AU - Ribas, Eduardo C.
AU - Vergani, Francesco
AU - Tolias, Christos M.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: Superior medullary velum cerebral cavernous malformations pose a challenge in terms of appropriate microsurgical approach. Safe access to this deep location as well as preservation of surrounding anatomical structures, in particular the superior cerebellar peduncle just lateral to the superior medullary velum and the dentate nuclei, is paramount to achieve a good functional outcome. Methods: Cadaveric dissections provide useful knowledge of the normal anatomy while tractography allows a better understanding of the individual anatomy in the presence of a lesion. The medial-tonsillar telovelar approach provides a feasible corridor for accessing superior velum cerebral cavernous malformations without compromising the fibres contained in the superior cerebellar peduncle. The major cerebellar efferents—cerebello-rubral, cerebello-thalamic and cerebello-vestibular tracts—and afferents, anterior spinocerebellar, tectocerebellar and trigeminocerebellar tracts, within the superior cerebellar peduncle are preserved, and the dentate nuclei are not affected. Results and conclusion: A retraction-free exposure through this natural posterior fossa corridor allows the patient with the anatomical and functional subtract to make a good functional recovery by minimizing the risk of a superior cerebellar syndrome, ataxia, tremor and dysmetria; decomposition of movement in the ipsilateral extremities, nystagmus and hypotonia; or akinetic mutism, reduced or absent speech with onset within the first post-operative week.
AB - Background: Superior medullary velum cerebral cavernous malformations pose a challenge in terms of appropriate microsurgical approach. Safe access to this deep location as well as preservation of surrounding anatomical structures, in particular the superior cerebellar peduncle just lateral to the superior medullary velum and the dentate nuclei, is paramount to achieve a good functional outcome. Methods: Cadaveric dissections provide useful knowledge of the normal anatomy while tractography allows a better understanding of the individual anatomy in the presence of a lesion. The medial-tonsillar telovelar approach provides a feasible corridor for accessing superior velum cerebral cavernous malformations without compromising the fibres contained in the superior cerebellar peduncle. The major cerebellar efferents—cerebello-rubral, cerebello-thalamic and cerebello-vestibular tracts—and afferents, anterior spinocerebellar, tectocerebellar and trigeminocerebellar tracts, within the superior cerebellar peduncle are preserved, and the dentate nuclei are not affected. Results and conclusion: A retraction-free exposure through this natural posterior fossa corridor allows the patient with the anatomical and functional subtract to make a good functional recovery by minimizing the risk of a superior cerebellar syndrome, ataxia, tremor and dysmetria; decomposition of movement in the ipsilateral extremities, nystagmus and hypotonia; or akinetic mutism, reduced or absent speech with onset within the first post-operative week.
KW - Cerebral cavernous malformation
KW - Superior cerebellar peduncle
KW - Superior medullary velum
KW - Tractography
UR - http://www.scopus.com/inward/record.url?scp=85086721048&partnerID=8YFLogxK
U2 - 10.1007/s00701-020-04418-2
DO - 10.1007/s00701-020-04418-2
M3 - Article
C2 - 32524247
AN - SCOPUS:85086721048
SN - 0001-6268
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
ER -