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C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video

C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional... SURGICAL VIDEO C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video Alejandro Enriquez-Marulanda, MD , ∗ ‡ Abdulrahman Y. Alturki, MBBS, MSc, FRCSC , ∗ ∗ Kimberly Kicielinski, MD, MPH , Ajith J. Thomas, MD , Christopher S. Ogilvy, MD Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard ‡ Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy066 Medical School, Boston, Massachusetts; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia Correspondence: Christopher S. Ogilvy, MD, Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215. E-mail: cogilvy@bidmc.harvard.edu We describe the case of a previously healthy 44-yr- under neurophysiologic monitoring was performed, and old female patient presenting with a sudden onset of complete resection of the lesion was achieved with mild numbness, paresthesias, and decreased sensation in her improvement of the sensitive symptoms and no evidence lower limbs. Physical examination revealed a decreased of new motor deficits. Any microsurgical resection of sensation to vibration and light touch in her lower extrem- a cervical spinal cord lesion can be technically difficult ities, primarily in the left limb. Impaired proprioception and adequate patient selection with evaluation of the was also evident primarily in the left toe. Full strength accessibility to the lesion is key. Surgical resection of with 2+ reflexes was observed in all extremities. Magnetic cavernous malformations in selected patients eliminates resonance imaging demonstrated an exophytic lesion in theriskoffuturehemorrhageandmayachievesatisfactory the posterior aspect of the cervical spinal cord at the C5-C6 outcomes comparable to patients who undergo conser- level, with a hemosiderin halo, consistent with a cavernous vative management. In the following video illustration, malformation. Given the evidence of past hemorrhage we narrate this operative case, and highlight the nuances and the location of the lesion, microsurgical intervention of this approach. Patient consent was obtained for the was indicated. A midline cervical C5-C6 laminectomy submission of the video to this journal. KEY WORDS: Cavernous malformation, Spinal cord, operative surgical procedure, microsurgery Operative Neurosurgery 16:E7, 2019 DOI:10.1093/ons/opy066 Received, November 27, 2017. Accepted, April 3, 2018. Published Online, April 6, 2018. Disclosure 2. Zhang L, Yang W, Jia W, et al. Comparison of outcome between surgical and conservative management of symptomatic spinal cord cavernous malformations. The authors have no personal, financial, or institutional interest in any of the Neurosurgery. 2016;78(4):552-561. drugs, materials, or devices described in this article. REFERENCES 1. Mitha AP, Turner JD, Spetzler RF. Surgical approaches to intramedullary cavernous malformations of the spinal cord. Neurosurgery. 2011;68(2 Suppl Operative):317-324; discussion 324. OPERATIVE NEUROSURGERY VOLUME 16 | NUMBER 1 | JANUARY 2019 | E7 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
DOI
10.1093/ons/opy066
Publisher site
See Article on Publisher Site

Abstract

SURGICAL VIDEO C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video Alejandro Enriquez-Marulanda, MD , ∗ ‡ Abdulrahman Y. Alturki, MBBS, MSc, FRCSC , ∗ ∗ Kimberly Kicielinski, MD, MPH , Ajith J. Thomas, MD , Christopher S. Ogilvy, MD Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard ‡ Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy066 Medical School, Boston, Massachusetts; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia Correspondence: Christopher S. Ogilvy, MD, Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215. E-mail: cogilvy@bidmc.harvard.edu We describe the case of a previously healthy 44-yr- under neurophysiologic monitoring was performed, and old female patient presenting with a sudden onset of complete resection of the lesion was achieved with mild numbness, paresthesias, and decreased sensation in her improvement of the sensitive symptoms and no evidence lower limbs. Physical examination revealed a decreased of new motor deficits. Any microsurgical resection of sensation to vibration and light touch in her lower extrem- a cervical spinal cord lesion can be technically difficult ities, primarily in the left limb. Impaired proprioception and adequate patient selection with evaluation of the was also evident primarily in the left toe. Full strength accessibility to the lesion is key. Surgical resection of with 2+ reflexes was observed in all extremities. Magnetic cavernous malformations in selected patients eliminates resonance imaging demonstrated an exophytic lesion in theriskoffuturehemorrhageandmayachievesatisfactory the posterior aspect of the cervical spinal cord at the C5-C6 outcomes comparable to patients who undergo conser- level, with a hemosiderin halo, consistent with a cavernous vative management. In the following video illustration, malformation. Given the evidence of past hemorrhage we narrate this operative case, and highlight the nuances and the location of the lesion, microsurgical intervention of this approach. Patient consent was obtained for the was indicated. A midline cervical C5-C6 laminectomy submission of the video to this journal. KEY WORDS: Cavernous malformation, Spinal cord, operative surgical procedure, microsurgery Operative Neurosurgery 16:E7, 2019 DOI:10.1093/ons/opy066 Received, November 27, 2017. Accepted, April 3, 2018. Published Online, April 6, 2018. Disclosure 2. Zhang L, Yang W, Jia W, et al. Comparison of outcome between surgical and conservative management of symptomatic spinal cord cavernous malformations. The authors have no personal, financial, or institutional interest in any of the Neurosurgery. 2016;78(4):552-561. drugs, materials, or devices described in this article. REFERENCES 1. Mitha AP, Turner JD, Spetzler RF. Surgical approaches to intramedullary cavernous malformations of the spinal cord. Neurosurgery. 2011;68(2 Suppl Operative):317-324; discussion 324. OPERATIVE NEUROSURGERY VOLUME 16 | NUMBER 1 | JANUARY 2019 | E7

Journal

Operative NeurosurgeryOxford University Press

Published: Jan 1, 2019

References