دورية أكاديمية
A taxonomy for brainstem cavernous malformations: subtypes of medullary lesions
| العنوان: | A taxonomy for brainstem cavernous malformations: subtypes of medullary lesions |
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| المؤلفون: | Catapano, Joshua S, Rumalla, Kavelin, Srinivasan, Visish M, Lawrence, Peter M, Larson Keil, Kristen, Lawton, Michael T |
| المصدر: | Neurosurgery |
| بيانات النشر: | Barrow - St. Joseph's Scholarly Commons |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | cavernoma, cuneate, far lateral approach, gracile, olivary, pyramidal, suboccipital craniotomy, trigonal, vascular disorders |
| الوصف: | OBJECTIVE: Medullary cavernous malformations are the least common of the brainstem cavernous malformations (BSCMs), accounting for only 14% of lesions in the authors' surgical experience. In this article, a novel taxonomy for these lesions is proposed based on clinical presentation and anatomical location. METHODS: The taxonomy system was applied to a large 2-surgeon experience over a 30-year period (1990-2019). Of 601 patients who underwent microsurgical resection of BSCMs, 551 were identified who had the clinical and radiological information needed for inclusion. These 551 patients were classified by lesion location: midbrain (151 [27%]), pons (323 [59%]), and medulla (77 [14%]). Medullary lesions were subtyped on the basis of their predominant surface presentation. Neurological outcomes were assessed according to the modified Rankin Scale (mRS), with an mRS score ≤ 2 defined as favorable. RESULTS: Five distinct subtypes were defined for the 77 medullary BSCMs: pyramidal (3 [3.9%]), olivary (35 [46%]), cuneate (24 [31%]), gracile (5 [6.5%]), and trigonal (10 [13%]). Pyramidal lesions are located in the anterior medulla and were associated with hemiparesis and hypoglossal nerve palsy. Olivary lesions are found in the anterolateral medulla and were associated with ataxia. Cuneate lesions are located in the posterolateral medulla and were associated with ipsilateral upper-extremity sensory deficits. Gracile lesions are located outside the fourth ventricle in the posteroinferior medulla and were associated with ipsilateral lower-extremity sensory deficits. Trigonal lesions in the ventricular floor were associated with nausea, vomiting, and diplopia. A single surgical approach was preferred (> 90% of cases) for each medullary subtype: the far lateral approach for pyramidal and olivary lesions, the suboccipital-telovelar approach for cuneate lesions, the suboccipital-transcisterna magna approach for gracile lesions, and the suboccipital-transventricular approach for trigonal lesions. Of these 77 patients for whom ... |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| العلاقة: | https://scholar.barrowneuro.org/neurosurgery/1555Test; https://doi.org/10.3171/2022.3.JNS22626Test |
| DOI: | 10.3171/2022.3.JNS22626 |
| الإتاحة: | https://doi.org/10.3171/2022.3.JNS22626Test https://scholar.barrowneuro.org/neurosurgery/1555Test |
| رقم الانضمام: | edsbas.6B6A4585 |
| قاعدة البيانات: | BASE |
| DOI: | 10.3171/2022.3.JNS22626 |
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