World Neurosurg. 2019 Dec 31;:
Authors: Rutkowski MJ, Ravina K, Carey JN, Russin JJ
Abstract
A previously healthy 44-year-old woman presented with a first-time seizure. Magnetic resonance imaging (MRI) revealed a right frontal intra-axial mass extending from the orbitofrontal gyri and gyrus rectus to the head of the caudate. The mass demonstrated heterogeneous signal intensity on pre-contrast T1-weighted MRI, minimal contrast enhancement, and mixed intensity on gradient echo MRI sequence consistent with a likely cavernous malformation. Given the location above the orbital roof with cranial-caudal extension to the level of the caudate, a transblepharo-preseptal modified orbitozygomatic craniotomy was recommended. With the assistance of plastic surgery, the lesion was approach through an eyelid incision that extended laterally to expose the keyhole. A McCarty burr hole was made, followed by a tailored orbitozygomatic craniotomy with osteotomies extending through the superolateral orbit and greater sphenoid wing to expose the proximal sylvian fissure. Dura was opened in a C-shaped fashion over the periorbital fat to allow for mild downward retraction of the globe, exposing the subfrontal trajectory. The opticocarotid cistern was opened to allow for cerebrospinal fluid egress and relaxation, and the lesion was readily identified through the use of stereotactic neuronavigation and the presence of a faint hemosiderin blush within the underlying parenchyma. Standard microsurgical technique was utilized to perform a gross total resection of the pathologically confirmed cavernous malformation. The orbitozygomatic bone flap was replaced and plated, and the wound closed in multiple layers. The patient was seen at a 3-month follow-up without further seizures.
PMID: 31901500 [PubMed - as supplied by publisher]
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