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Navigation-guided endoscopic transcerebellar approach for cyst fenestration of a dorsal brainstem lesion:
Shigeki Takada1,2, Takaaki Morita1, Etsuko Yamamoto Hattori1
1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.
Background:
Surgical fenestration of dorsal brainstem cysts is commonly challenging to perform because of difficulties in selecting an optimal surgical corridor. Herein, the authors report a case of a dorsal brainstem cyst that was successfully treated with a navigation-guided endoscopic transcerebellar approach.
Observations:
A 9-year-old boy was diagnosed with optic pathway pilocytic astrocytoma at the age of 3 years. Subsequently, he required multiple procedures for tumor recurrence and growth of the cystic component. Despite these treatments, the dorsal brainstem cyst gradually enlarged, causing compression of the brainstem and fourth ventricle. A navigation-guided endoscopic transcerebellar approach for cyst fenestration was planned. The cyst wall was widely fenestrated via the suprafacial triangle on the floor of the fourth ventricle. Postoperatively, the patient developed transient truncal ataxia. However, he was discharged home after 2 weeks without neurological deficits.
Lessons:
A navigation-guided endoscopic transcerebellar approach can be effective for dorsal brainstem cyst treatment. The surgical corridor is direct and linear, thereby allowing easy and reliable access. The entry point into the cyst should be located in the rostral portion of the floor of the fourth ventricle. Hence, it is important to create a sufficiently wide communication between the cyst and the fourth ventricle. https://thejns.org/doi/10.3171/CASE26161.
