This past year, the UCSF Neurosurgery team has begun using a new 4K Ultra HD intraoperative microscope, which allows for enhanced teaching and presentation of surgical videos – at four times the resolution of traditional 1080p High Definition videos.
In this intraoperative video, watch UCSF neurosurgeon Adib Abla, MD, remove a cavernous angioma in the brainstem. The 28-year-old patient initially presented with double vision, and was found to have a ruptured cavernous angioma (also called cavernous malformation, CM). CMs are mulberry-shaped clusters of abnormal blood vessels, which may hemorrhage and cause a range of symptoms, depending on their location in the brain. For example, some cavernous angiomas cause seizures, whereas brainstem CMs typically cause vision problems.
This brainstem lesion was removed using a transpontomedullary sulcus approach, which was first described here at UCSF.1 Due to their location, only about half or fewer pontine CMs are even considered resectable. However, the transpontomedullary sulcus approach, although technically challenging, grants access to a portion of these deep seated pontine lesions which might not otherwise be surgically feasible.
References
1. Abla AA, Benet A, Lawton MT. (2014) The far lateral transpontomedullary sulcus approach to pontine cavernous malformations: technical report and surgical results. Neurosurgery 10 Suppl 3:472-80. doi: 10.1227/NEU.0000000000000389.
