Cavernoma of the left ventral striatum, anatomical and microsurgical implications of the ipsilateral transcallosal transrostral pathway.

Surgical neurology international Pub Date : 2025-05-23 eCollection Date: 2025-01-01 DOI:10.25259/SNI_285_2025
Alejandro Benjamin Romero Leguina, Luis Ángel Canache Jiménez, Mariano Teyssandier, Álvaro Rodrigo Quiñones Céspedes, Sebastian Juan Mária Giovannini, Mariela Cecilia Salerno, Erica Antunes Effgen, Érico Samuel Gomes Galvão da Trindade, José Maria de Campos Filho, Feres Chaddad-Neto
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Abstract

Background: Cerebral cavernous malformations are vascular abnormalities of the central nervous system with an incidence of 0.4-0.5% and an annual hemorrhage rate ranging from 0.7% to 1%. The most important and consistent risk factor for rebleeding is a prior hemorrhage, and deep lesions (within the thalamus, basal ganglia, and brainstem) characteristically carry a worse prognosis regarding annual hemorrhage rates (10.6% per patient per year vs 0.4% per patient per year for superficial cerebral lesions) and subsequent neurologic deterioration. The ventral striatum is a difficult region to approach. The conservative treatment and also radiosurgery are not compatible with this kind of lesion, in the virtue of the eloquence and high risk of rebleeding, and the worsening of the perilesional edema, respectively, resulting in a motor deficit.

Case description: This video presents a case of a 37-year-old male patient with a 6-month history of headaches, with a magnetic resonance imaging (MRI) showing a lesion in the left ventral striatum compatible with cavernoma with signs of recent bleeding. The patient underwent an ipsilateral transcallosal transrostral approach. The procedure was uneventful, and the patient was discharged without neurological deficits. A postoperative MRI confirmed complete resection.

Conclusion: The anatomical aspects to consider are analyzed as the dissection progresses toward the lesion, and the other surgical alternatives are studied in this video. The ipsilateral transcallosal transrostral pathway permits an intuitive awareness of the midline at all times, facilitating safer manipulation of the brain tissue when accessing deep-seated lesions. Consequently, the risk of intraoperative and postoperative complications decreases.

左侧腹侧纹状体海绵状瘤,同侧经胼胝体经鼻侧通路的解剖学和显微外科意义。
背景:脑海绵体畸形是中枢神经系统的血管异常,发病率为0.4-0.5%,年出血率为0.7% - 1%。再出血最重要和一致的危险因素是既往出血,深部病变(丘脑、基底神经节和脑干)的预后通常较差,其年出血率为10.6% /例,浅表脑病变为0.4% /例)和随后的神经系统恶化。腹侧纹状体是一个难以接近的区域。保守治疗和放射手术均不能与这种病变相适应,分别具有再出血的危险性和再出血的危险性,以及加重病灶周围水肿,导致运动障碍。病例描述:本视频报告一位37岁男性患者,有6个月的头痛病史,磁共振成像(MRI)显示左侧腹侧纹状体病变与海绵状瘤相符,近期有出血迹象。患者接受了同侧经胼胝体经鼻侧入路。手术过程很顺利,病人出院时没有神经功能障碍。术后MRI证实完全切除。结论:在本视频中,我们分析了解剖过程中需要考虑的解剖学方面,并对其他手术方案进行了研究。同侧经胼胝体经鼻侧通路在任何时候都能直观地感知中线,便于在触及深部病变时更安全地操作脑组织。因此,术中和术后并发症的风险降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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