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Surgery for Vascular Lesions of the Brainstem

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Brainstem Tumors

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Abstract

Vascular lesions of the brainstem are among the most complicated lesions treated by cerebrovascular neurosurgeons. Aneurysms, arteriovenous malformations, and cavernous malformations can be found in close association with all levels of the brainstem. Due to the inherent risk of treating brainstem pathologies, all surgical decision-making must first be predicated on knowledge of the natural history and radiographic appearance of these lesions. Successful microsurgical treatment of these lesions demands familiarity with an array of skull base approaches, which force surgeons to operate in deeper and narrower surgical corridors than with a corresponding supratentorial pathology. A regional understanding of the neurovascular anatomy that is unique to the midbrain, pons and medulla guides surgical planning. Advanced techniques are used when standard approaches cannot be performed safely, such as cerebral revascularization for complex aneurysms or in situ disconnection without pial dissection for arteriovenous malformations. With careful patient selection and dedication to developing the technical mastery necessary to operate in and around critical brainstem structures, vascular pathology of the brainstem can be treated safely.

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Abbreviations

AICA:

Anterior inferior cerebellar artery

AVM:

Arteriovenous malformation(s)

BA:

Basilar artery

BRAT:

Barrow Ruptured Aneurysm Trial

BT:

Basilar trunk

BVR:

Basal vein of Rosenthal

CM:

Cavernous malformation

CN:

Cranial nerve

CSF:

Cerebrospinal fluid

CST:

Corticospinal tracts

CT:

Computed tomography

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

DTI:

Diffusion tensor imaging

IA:

Intracranial aneurysm

IAC:

Internal auditory canal

ISAT:

International Subarachnoid Aneurysm Trial

ISUIA:

International Study of Unruptured Intracranial Aneurysms

MAPonMesV:

Median anterior pontomesencephalic vein

MCP(s):

Middle cerebellar peduncle(s)

mOZ:

Modified orbitozygomatic

MRA:

MR angiography

MRI:

Magnetic resonance imaging

OA-PICA EC-IC:

Occipital artery-posterior inferior cerebellar artery external carotid-internal carotid

OZ:

Orbitozygomatic

PCA:

Posterior cerebral arteries

PCP:

Posterior clinoid process

PICA:

Posterior inferior cerebellar artery

SAH:

Subarachnoid hemorrhage

SCA:

Superior cerebellar artery

SCIT:

Supracerebellar infratentorial

SPetrV:

Superior petrosal vein

SPS:

Superior petrosal sinus

SS-EPI:

Single-shot echo planar imaging

T2∗GRE:

T2∗-Gradient Recalled Echo

VA:

Vertebral arteries

VBJ:

Vertebrobasilar junction

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Authors and Affiliations

  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Michael J. Lang & Michael T. Lawton

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  1. Michael J. Lang
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  2. Michael T. Lawton
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Correspondence to Michael T. Lawton .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    George I. Jallo

  2. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    Mohammad Hassan A. Noureldine

  3. Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA

    Nir Shimony

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Lang, M.J., Lawton, M.T. (2020). Surgery for Vascular Lesions of the Brainstem. In: Jallo, G., Noureldine, M., Shimony, N. (eds) Brainstem Tumors. Springer, Cham. https://doi.org/10.1007/978-3-030-38774-7_9

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  • DOI: https://doi.org/10.1007/978-3-030-38774-7_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38773-0

  • Online ISBN: 978-3-030-38774-7

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