TY - JOUR
T1 - Intraventricular Choroid Plexus Cavernoma Resection Using Tubular Retractor System and Exoscope Visualization
T2 - A Technical Case Report
AU - Li, Boyi
AU - Kim, Michael G.
AU - Dominguez, Jose
AU - Feldstein, Eric
AU - Kleinman, George
AU - Hanft, Simon
N1 - Publisher Copyright: Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - BACKGROUND AND IMPORTANCE: Cavernous malformations (CMs) account for approximately 5% to 10% of all CNS vascular malformations, and intraventricular CMs (IVCMs) are a rare subtype, accounting for 2.5% to 10.8% of all intracranial CMs. IVCMs can expand rapidly, leading to compression of adjacent structures, intraventricular hemorrhage, and obstructive hydrocephalus. Diagnosis is challenging because it can mimic a variety of other lesions. CLINICAL PRESENTATION: A 71-year-old man presented after a fall because of imbalance. MRI of the head showed a homogenously enhancing 2-cm mass in the posterior aspect of the right lateral ventricle, with blood layering in the right occipital horn and adjacent parietal edema and leptomeningeal enhancement, as well as a pituitary lesion. DISCUSSION: The patient underwent a right parietal craniotomy for resection of the mass. The ventricle was accessed through a transsulcal approach through the intraparietal sulcus using a tubular retractor system. The mass was arising from the choroid plexus and dissected free in a piecemeal fashion. Postoperative imaging confirmed gross total resection, and the patient had an uneventful recovery. CONCLUSION: Here, we present the first case of a choroid plexus IVCM removed using a tubular retractor system. We demonstrate that this is a safe and effective approach for this rare lesion given the minimal traction on brain parenchyma and enhanced visualization of a deep-seated cavernoma in the lateral ventricle.
AB - BACKGROUND AND IMPORTANCE: Cavernous malformations (CMs) account for approximately 5% to 10% of all CNS vascular malformations, and intraventricular CMs (IVCMs) are a rare subtype, accounting for 2.5% to 10.8% of all intracranial CMs. IVCMs can expand rapidly, leading to compression of adjacent structures, intraventricular hemorrhage, and obstructive hydrocephalus. Diagnosis is challenging because it can mimic a variety of other lesions. CLINICAL PRESENTATION: A 71-year-old man presented after a fall because of imbalance. MRI of the head showed a homogenously enhancing 2-cm mass in the posterior aspect of the right lateral ventricle, with blood layering in the right occipital horn and adjacent parietal edema and leptomeningeal enhancement, as well as a pituitary lesion. DISCUSSION: The patient underwent a right parietal craniotomy for resection of the mass. The ventricle was accessed through a transsulcal approach through the intraparietal sulcus using a tubular retractor system. The mass was arising from the choroid plexus and dissected free in a piecemeal fashion. Postoperative imaging confirmed gross total resection, and the patient had an uneventful recovery. CONCLUSION: Here, we present the first case of a choroid plexus IVCM removed using a tubular retractor system. We demonstrate that this is a safe and effective approach for this rare lesion given the minimal traction on brain parenchyma and enhanced visualization of a deep-seated cavernoma in the lateral ventricle.
UR - http://www.scopus.com/inward/record.url?scp=85124636546&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124636546&partnerID=8YFLogxK
U2 - https://doi.org/10.1227/ONS.0000000000000075
DO - https://doi.org/10.1227/ONS.0000000000000075
M3 - Article
C2 - 35030141
VL - 22
SP - e134-e137
JO - Operative Neurosurgery
JF - Operative Neurosurgery
SN - 2332-4252
IS - 3
ER -