SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS
Introduction Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and...
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| Format: | Article |
| Language: | English |
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London Academic Publishing
2024-11-01
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| Series: | Romanian Neurosurgery |
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| Online Access: | http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2832 |
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| author | Claudiu Matei Dan Filip Iulia Dancu Sofia Nistor Joseph Gherman |
| author_facet | Claudiu Matei Dan Filip Iulia Dancu Sofia Nistor Joseph Gherman |
| author_sort | Claudiu Matei |
| collection | DOAJ |
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Introduction
Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and can cause devastating neurological deficits. Surgical approach to thalamic cavernomas is associated with risks of new or worsening neurologic deficits. The benefit of surgery must be carefully weighed on an individualized basis. There are several surgical routes that can be used to approach thalamic lesions, mainly transcortical and interhemispheric approaches. A particular approach should be selected based on the location of the cavernoma in the thalamus to minimize lesion of the unaffected brain.
Methods
We present the case of a 43-year-old right-handed lady with right bleeding posterolateral thalamic cavernoma, admitted to the neurosurgery department of Sibiu MedLife Polisano Hospital in February 2024. The patient underwent surgery, through a transcortical trans-sulcal para-fascicular, navigation guided approach. Preoperative tractography imaging, tubular cerebral corridor retractor system and intraoperative monitoring of the cortico-spinal tract, through motor evoked potentials (transcortical, cortical and subcortical mapping) and of the spinotahamic tract through somatosensory evoked potentials were used. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day.
Conclusions
Thalamus is a complex structure located in a deep brain area and surgery for these region carries high risks, so the surgeon must carefully tailor these patients. The transcortical transsulcal para-fascicular approach is feasible and safe using the cerebral tubular corridor, neuronavigation and neuromonitoring. Advanced surgical technology offers the advantages of minimizing the risks of new neurological deficits.
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| format | Article |
| id | doaj-art-29a759b7c3a443d4b3a4fe0ca6b2e0f8 |
| institution | Kabale University |
| issn | 1220-8841 2344-4959 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | London Academic Publishing |
| record_format | Article |
| series | Romanian Neurosurgery |
| spelling | doaj-art-29a759b7c3a443d4b3a4fe0ca6b2e0f82024-11-14T15:47:07ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592024-11-0138Special Issue10.33962/roneuro-2024-107SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONSClaudiu MateiDan FilipIulia DancuSofia NistorJoseph Gherman Introduction Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and can cause devastating neurological deficits. Surgical approach to thalamic cavernomas is associated with risks of new or worsening neurologic deficits. The benefit of surgery must be carefully weighed on an individualized basis. There are several surgical routes that can be used to approach thalamic lesions, mainly transcortical and interhemispheric approaches. A particular approach should be selected based on the location of the cavernoma in the thalamus to minimize lesion of the unaffected brain. Methods We present the case of a 43-year-old right-handed lady with right bleeding posterolateral thalamic cavernoma, admitted to the neurosurgery department of Sibiu MedLife Polisano Hospital in February 2024. The patient underwent surgery, through a transcortical trans-sulcal para-fascicular, navigation guided approach. Preoperative tractography imaging, tubular cerebral corridor retractor system and intraoperative monitoring of the cortico-spinal tract, through motor evoked potentials (transcortical, cortical and subcortical mapping) and of the spinotahamic tract through somatosensory evoked potentials were used. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Conclusions Thalamus is a complex structure located in a deep brain area and surgery for these region carries high risks, so the surgeon must carefully tailor these patients. The transcortical transsulcal para-fascicular approach is feasible and safe using the cerebral tubular corridor, neuronavigation and neuromonitoring. Advanced surgical technology offers the advantages of minimizing the risks of new neurological deficits. http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2832cavernomaneuronavigationsubcortical mappingmotor evoked potentialtubular retractor |
| spellingShingle | Claudiu Matei Dan Filip Iulia Dancu Sofia Nistor Joseph Gherman SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS Romanian Neurosurgery cavernoma neuronavigation subcortical mapping motor evoked potential tubular retractor |
| title | SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS |
| title_full | SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS |
| title_fullStr | SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS |
| title_full_unstemmed | SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS |
| title_short | SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS |
| title_sort | surgical approach to thalamic cavernous malformations |
| topic | cavernoma neuronavigation subcortical mapping motor evoked potential tubular retractor |
| url | http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2832 |
| work_keys_str_mv | AT claudiumatei surgicalapproachtothalamiccavernousmalformations AT danfilip surgicalapproachtothalamiccavernousmalformations AT iuliadancu surgicalapproachtothalamiccavernousmalformations AT sofianistor surgicalapproachtothalamiccavernousmalformations AT josephgherman surgicalapproachtothalamiccavernousmalformations |