Abstract
Background
For small and lateral lesions, in order to avoid postoperative sequelae related to dorso-median myelotomy, we propose to describe the use of a ventrolateral approach for intramedullary lesions.
Method
Performing this approach entails that the denticulate ligament is cut from its dural attachment and retracted. Rotation of the spinal cord must be achieved with great caution and under electrophysiological monitoring. After pia mater incision, hydrodissection is useful to gently dissect the cavernoma and promote a cleavage plane.
Conclusion
In the case of lateral intramedullary lesions, using this approach maximized the absence of postoperative deficit.
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References
Mertens P, Sindou M (2000) Surgery in the dorsal root entry zone for treatment of chronic pain. Neurochirurgie 46(5):429–446
Dauleac C, Jacquesson T, Mertens P (2019) Anatomy of the human spinal cord arachnoid cisterns: applications for spinal cord surgery. J Neurosurg Spine:1–8
Tubbs RS, Salter G, Grabb PA, Oakes WJ (2001) The denticulate ligament: anatomy and functional significance. J Neurosurg 94(2 Suppl):271–275
Klekamp J, Samii M (2007) Surgery of spinal tumors. Springer-Verlag, Berlin Heidelberg
Endo T, Wenting J, Nakagawa A, Endo H, Sagae Y, Iwasaki M, Tominaga T (2017) New application of actuator-driven pulsed water jet for spinal cord dissection: an experimental study in pigs. J Neurol Surg A Cent Eur Neurosurg 78(2):137–143
Ardeshiri A, Özkan N, Chen B, Stein K-P, Miller D, Hütter B-O, Sandalcioglu IE, Sure U (2016) A retrospective and consecutive analysis of the epidemiology and management of spinal cavernomas over the last 20 years in a single center. Neurosurg Rev 39(2):269–276 discussion 276
Deutsch H, Jallo GI, Faktorovich A, Epstein F (2000) Spinal intramedullary cavernoma: clinical presentation and surgical outcome. J Neurosurg 93(1 Suppl):65–70
Dauleac C, Frindel C, Cotton F, Pelissou-Guyotat I (2019) Tractography-based surgical strategy for cavernoma of the conus medullaris: case illustration. J Neurosurg Spine:1–2
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Key Points
• When surgery is indicated, gross-total resection is the goal, as remnants can lead to rebleeding and aggravation of the neurological status.
• Intraoperative electrophysiological monitoring is essential to avoid neurological deterioration during surgical resection.
• When an exophytic component is present, the microsurgical dissection must start from the extramedullary location. When it is not the case, incision of the pia mater must be done with caution and after electrophysiological checks.
• Similarly to tumor resection, hydrodissection (water jet dissection) is useful to gently dissect the cavernoma and promote a cleavage plane.
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This article is part of the Topical Collection on: Vascular Neurosurgery – Other
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Dauleac, C., Pelissou-Guyotat, I. How I do it: dorsolateral approach for ventrolateral intramedullary cavernoma. Acta Neurochir 162, 1127–1129 (2020). https://doi.org/10.1007/s00701-019-04188-6
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DOI: https://doi.org/10.1007/s00701-019-04188-6