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J Neurol Surg A Cent Eur Neurosurg 2016; 77(03): 269-273
DOI: 10.1055/s-0035-1549305
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Outcome of Endonasal Transsphenoidal Approach for the Treatment of Pontine Cavernous Malformation: Case Report with 11 Years of Follow-Up

Péter Banczerowski
1   Department of Neurosurgery, National Institute of Neurosurgery, Budapest, Hungary
2   Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
,
Gábor Czigléczki
2   Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
,
Ildikó Gádor
3   Department of Otolaryngology, National Institute of Neurosurgery, Budapest, Hungary
,
István Nyáry
1   Department of Neurosurgery, National Institute of Neurosurgery, Budapest, Hungary
2   Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
› Author Affiliations
Further Information

Publication History

14 May 2014

06 February 2015

Publication Date:
22 May 2015 (online)

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Abstract

Ventromedial localized cavernous malformations in the pons pose a difficult problem because of their surgical access and the high risk of deleterious consequences due to damage of the surrounding tissues. We report an endonasal transsphenoidal approach for the treatment of ventromedial pontine cavernomas that also follows principles of optimal access known as the “two-point method” for the resection of cavernous malformations. A 31-year-old woman presented with sudden left hemiparesis, nausea, and headache. Radiologic findings demonstrated a ventral pontine cavernous malformation in the midline slightly extending to the right, together with signs of acute hemorrhage. Surgical intervention was performed, and the cavernoma was completely resected via a transnasal transsphenoidal approach. Cerebrospinal fluid (CSF) rhinorrhea that ensued postoperatively needed an additional reconstructive surgery using the same approach. No further CSF leakage was evident, and an 11-year follow-up examination revealed neither signs of neurologic deficit nor recurrence of the resected pontine cavernoma. The long-term outcome proves the effectiveness and safety of this novel surgical route in the treatment of ventromedial cavernous malformations in the pons.

Keywords

pontine cavernous malformation - endonasal - transsphenoidal - nonendoscopic - long-term outcome
 

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