Intraoperative motor mapping of the cerebral peduncle during resection of a midbrain cavernous malformation: Technical case report

Alfredo Quinones-Hinojosa, Russ Lyon, Rose Du, Michael T. Lawton

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Brainstem cavernous malformations that seem to come to a pial or ependymal surface on preoperative magnetic resonance imaging studies may, in fact, be covered by an intact layer of neural tissue. For cavernous malformations in the cerebral peduncle, intraoperative stimulation mapping with a miniaturized probe can determine whether this overlying tissue harbors fibers in the corticospinal tract. In addition, intermittent monitoring with transcranial motor evoked potentials (TcMEPs) helps to protect this vital pathway during resection of the lesion. CLINICAL PRESENTATION: A 20-year-old woman collapsed after a cavernous malformation in the left cerebral peduncle hemorrhaged into the pons, midbrain, and thalamus. She presented with right hemiparesis and left oculomotor palsy. INTERVENTION: The cavernous malformation was completely resected through a left orbitozygomatic craniotomy and transsylvian approach. Stimulation mapping of the cerebral peduncle with a Kartush probe (Medtronic Xomed, Inc., Jacksonville, FL) identified the corticospinal tract lateral to the lesion, and a layer of tissue over the lesion harbored no motor fibers. TcMEP monitoring helped to guide the resection, with increased voltage thresholds and altered waveform morphologies indicating transient impaired motor conduction. All TcMEP changes returned to baseline by the end of the procedure, and the patient's hemiparesis improved after surgery. CONCLUSION: Stimulation mapping of the corticospinal tract and intermittent TcMEPs is a safe and simple surgical adjunct. Expanded monitoring of the motor pathway during the resection of cerebral peduncle cavernous malformations may improve the safety of these operations.

Original languageEnglish (US)
JournalNeurosurgery
Volume56
Issue number4 SUPPL.
DOIs
StatePublished - Apr 2005
Externally publishedYes

Fingerprint

Motor Evoked Potentials
Mesencephalon
Pyramidal Tracts
Paresis
Central Nervous System Cavernous Hemangioma
Efferent Pathways
Pons
Craniotomy
Thalamus
Paralysis
Brain Stem
Magnetic Resonance Imaging
Safety
Cerebral Peduncle

Keywords

  • Cavernous malformation
  • Intraoperative stimulation
  • Motor evoked potential
  • Neuromonitoring
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Intraoperative motor mapping of the cerebral peduncle during resection of a midbrain cavernous malformation : Technical case report. / Quinones-Hinojosa, Alfredo; Lyon, Russ; Du, Rose; Lawton, Michael T.

In: Neurosurgery, Vol. 56, No. 4 SUPPL., 04.2005.

Research output: Contribution to journalArticle

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