Supracerebellar infratentorial resection of a torcular lesion causing fulminant intracranial hypertension: illustrative case.

Autor:	Dallas J; 1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California., Lane JR; 2Department of Neurological Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia., Hopkins BS; 1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California., Chang M; 3Division of Ophthalmology, Children's Hospital Los Angeles, Los Angeles, California., Borchert M; 3Division of Ophthalmology, Children's Hospital Los Angeles, Los Angeles, California., Gonzalez NR; 4Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, California; and., Chiarelli PA; 1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.; 5Department of Surgery, Division of Neurological Surgery, Children's Hospital Los Angeles, Los Angeles, California., Chu JK; 1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.; 5Department of Surgery, Division of Neurological Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Dec 18; Vol. 6 (25). Date of Electronic Publication: 2023 Dec 18 (Print Publication: 2023).
DOI:	10.3171/CASE23363
Abstrakt:	Background: Venous sinus stenosis has been implicated in intracranial hypertension and can lead to papilledema and blindness. The authors report the unique case of a cerebellar transtentorial lesion resulting in venous sinus stenosis in the torcula and bilateral transverse sinuses that underwent resection. Observations: A 5-year-old male presented with subacute vision loss and bilateral papilledema. Imaging demonstrated a lesion causing mass effect on the torcula/transverse sinuses and findings of increased intracranial pressure (ICP). A lumbar puncture confirmed elevated pressure, and the patient underwent bilateral optic nerve sheath fenestration. Cerebral angiography and venous manometry showed elevated venous sinus pressures suggestive of venous hypertension. The patient underwent a craniotomy and supracerebellar/infratentorial approach. A stalk emanating from the cerebellum through the tentorium was identified and divided. Postoperative magnetic resonance imaging showed decreased lesion size and improved sinus patency. Papilledema resolved and other findings of elevated ICP improved. Pathology was consistent with atrophic cerebellar cortex. Serial imaging over 6 months demonstrated progressive decrease in the lesion with concurrent improvements in sinus patency. Lessons: Although uncommon, symptoms of intracranial hypertension in patients with venous sinus lesions should prompt additional workup ranging from dedicated venous imaging to assessments of ICP and venous manometry.
Databáze:	MEDLINE
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