Optimal access route for pontine cavernous malformation resection with preservation of abducens and facial nerve function
| Autor: | Shinya Ichimura, Caiquan Huang, Souvik Kar, Helmut Bertalanffy, Yoshihito Tsuji |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Access route business.industry General Medicine Cavernous malformations medicine.disease Facial nerve Pons Surgery Lesion 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale 030220 oncology & carcinogenesis Cohort Medicine medicine.symptom business Abducens nerve 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurosurgery. |
| ISSN: | 1933-0693 |
| Popis: | OBJECTIVE The aim of this study was to analyze the differences between posterolateral and posteromedial approaches to pontine cavernous malformations (PCMs) in order to verify the hypothesis that a posterolateral approach is more favorable with regard to preservation of abducens and facial nerve function. METHODS The authors conducted a retrospective analysis of 135 consecutive patients who underwent microsurgical resection of a PCM. The vascular lesions were first classified in a blinded fashion into 4 categories according to the possible or only reasonable surgical access route. In a second step, the lesions were assessed according to which approach was performed and different patient groups and subgroups were determined. In a third step, the modified Rankin Scale score and the rates of permanent postoperative abducens and facial nerve palsies were assessed. RESULTS The largest group in this series comprised 77 patients. Their pontine lesion was eligible for resection from either a posterolateral or posteromedial approach, in contrast to the remaining 3 patient groups in which the lesion location already had dictated a specific surgical approach. Fifty-four of these 77 individuals underwent surgery via a posterolateral approach and 23 via a posteromedial approach. When comparing these 2 patient subgroups, there was a statistically significant difference between postoperative rates of permanent abducens (3.7% vs 21.7%) and facial (1.9% vs 21.7%) nerve palsies. In the entire patient population, the abducens and facial nerve deficit rates were 5.9% and 5.2%, respectively, and the modified Rankin Scale score significantly decreased from 1.6 ± 1.1 preoperatively to 1.0 ± 1.1 at follow-up. CONCLUSIONS The authors' results suggest favoring a posterolateral over a posteromedial access route to PCMs in patients in whom a lesion is encountered that can be removed via either surgical approach. In the present series, the authors have found such a constellation in 57% of all patients. This retrospective analysis confirms their hypothesis in a large patient cohort. Additionally, the authors demonstrated that 4 types of PCMs can be distinguished by preoperatively evaluating whether only one reasonable or two alternative surgical approaches are available to access a specific lesion. The rates of postoperative sixth and seventh nerve palsies in this series are substantially lower than those in the majority of other published reports. |
| Databáze: | OpenAIRE |
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