Affiliation:
1. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
Abstract
Abstract
Neurenteric cysts are rare congenital lesions that may compress the ventral brainstem.1-9 In this operative video, we illustrate the surgical treatment of an intradural extra-axial neurenteric cyst extending from the lower pons to the craniocervical junction. The patient, an asymptomatic 52-yr-old female, underwent surveillance imaging of the premedullary lesion for 14 yr without progression. However, after developing progressive strain-induced headaches, imaging revealed a significant enlargement of the lesion with brainstem compression and partial obstruction of the foramen magnum. Therefore, surgical resection was pursued. The patient consented to the procedure.
The patient underwent a lateral suboccipital craniotomy and C1 laminectomy through a far lateral approach. The lesion was immediately visualized upon opening the dura. After identifying the cranial nerves, we resected the tumor while taking care to preserve the neurovascular elements of the cerebellopontine angle and foramen magnum. During the resection, we unexpectedly encountered a firm nodule that was adherent to the right posterior inferior cerebellar artery. This was meticulously dissected and removed en bloc using intraoperative indocyanine green (ICG) angiography. The cavity was inspected with 0-degree and 30-degree endoscopes to ensure complete resection of the lesion.
Gross total resection was confirmed on postoperative magnetic resonance imaging. The patient was neurologically intact with no cranial nerve abnormalities and discharged home on postoperative day 3. This case demonstrates that the far lateral-supracondylar approach affords safe access to the ventral pontomedullary and craniocervical junctions and that intraoperative adjuncts, including ICG angiography and endoscopic visualization, can facilitate complete lesion resection with excellent clinical outcomes.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery
Reference9 articles.
1. Neurenteric cyst of the craniocervical junction. Report of three cases;Filho;J Neurosurg,2001
2. Neurenteric cyst at the craniovertebral junction: report of two cases;Fuse;Surg Neurol,1998
3. Resection of a neuroenteric cyst using a far lateral approach;Gozal;J Neurol Surg B Skull Base,2019
4. Partial transcondylar approach for ventral foramen magnum neurenteric cyst: 2-dimensional operative video;Matsushima;Oper Neurosurg,2019
5. Neurenteric cyst of the ventral craniocervical junction: case report and review of the literature;Menendez;World Neurosurg,2019
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献