Custom-tailored minimally invasive partial C2-corpectomy for ventrally located intramedullary cavernous malformation

TY - JOUR

T1 - Custom-tailored minimally invasive partial C2-corpectomy for ventrally located intramedullary cavernous malformation

AU - Eicker, Sven O

AU - Eicker, Sve O

AU - Szelényi, Andrea

AU - Mathys, Christian

AU - Steiger, Hans-Jakob

AU - Hänggi, Daniel

PY - 2013/7

Y1 - 2013/7

N2 - Approaches to ventrally located intramedullary lesions of the upper cervical spine can be extremely challenging. We present a custom-tailored, minimally invasive anterior approach to a ventrally located, intramedullary cavernous hemangioma with partial lateral corpectomy of C2, complete resection of the lesion and subsequent reconstruction. A 20-year-old woman presented with the history of progressive numbness of the left upper and lower extremities and some episodes of severe headaches was referred to magnetic resonance imaging: Here, an intramedullary lesion with typical radiological features for a cavernous malformation at the ventral surface of the spinal cord at the C2 level was detected. The surgical procedure was performed under general anesthesia and electrophysiological monitoring (somatosensory-evoked potentials (SEP), muscle motor-evoked potentials (MEP), and D-wave recording). Complete resection of the cavernous malformation was achieved and reconstruction of the cervical spine was performed using a custom-tailored cage. Intraoperative neuromonitoring during resection, revealed a transient MEP loss, but unchanged D-wave and SEP recordings indicated unchanged neurological outcome. Early clinical follow-up of the patient revealed no new neurological deficits. At 3-month follow-up, there was some improvement of the sensory function. This custom-tailored minimally invasive anterior approach to a ventrally located intramedullary cavernous malformation with partial C2-corpectomy describes a possible and successful approach to ventrally located intramedullary lesions of the upper cervical spinal cord. Additionally, the hereby-described approach is not related to cervical instability.

AB - Approaches to ventrally located intramedullary lesions of the upper cervical spine can be extremely challenging. We present a custom-tailored, minimally invasive anterior approach to a ventrally located, intramedullary cavernous hemangioma with partial lateral corpectomy of C2, complete resection of the lesion and subsequent reconstruction. A 20-year-old woman presented with the history of progressive numbness of the left upper and lower extremities and some episodes of severe headaches was referred to magnetic resonance imaging: Here, an intramedullary lesion with typical radiological features for a cavernous malformation at the ventral surface of the spinal cord at the C2 level was detected. The surgical procedure was performed under general anesthesia and electrophysiological monitoring (somatosensory-evoked potentials (SEP), muscle motor-evoked potentials (MEP), and D-wave recording). Complete resection of the cavernous malformation was achieved and reconstruction of the cervical spine was performed using a custom-tailored cage. Intraoperative neuromonitoring during resection, revealed a transient MEP loss, but unchanged D-wave and SEP recordings indicated unchanged neurological outcome. Early clinical follow-up of the patient revealed no new neurological deficits. At 3-month follow-up, there was some improvement of the sensory function. This custom-tailored minimally invasive anterior approach to a ventrally located intramedullary cavernous malformation with partial C2-corpectomy describes a possible and successful approach to ventrally located intramedullary lesions of the upper cervical spinal cord. Additionally, the hereby-described approach is not related to cervical instability.

KW - Evoked Potentials, Motor

KW - Evoked Potentials, Somatosensory

KW - Female

KW - Hemangioma, Cavernous, Central Nervous System

KW - Hematoma, Epidural, Spinal

KW - Humans

KW - Longitudinal Ligaments

KW - Magnetic Resonance Imaging

KW - Minimally Invasive Surgical Procedures

KW - Monitoring, Physiologic

KW - Neurosurgical Procedures

KW - Spine

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1007/s10143-013-0457-y

DO - 10.1007/s10143-013-0457-y

M3 - SCORING: Journal article

C2 - 23568696

VL - 36

SP - 487

EP - 491

JO - NEUROSURG REV

JF - NEUROSURG REV

SN - 0344-5607

IS - 3

ER -