Neuronavigation-guided wake-up craniotomy for left temporal cavernous haemangioma
Author(s): ,
J. Paquet
UZ Gent, Gent, Belgium
T. Couvreur
AZ Delta, Roeselare, Belgium
O. Van Damme
AZ Delta, Roeselare, Belgium
D. Vanhauwaert
AZ Delta, Roeselare, Belgium
EANS Academy. Paquet J. 10/21/18; 226050; EP1117
Jan Paquet
Jan Paquet
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Introduction: Awake craniotomy has been introduced for cortical and subcortical mapping to minimize postoperative neurological deficits after tumour and epilepsy surgery in eloquent areas. We describe a case of neuronavigation-guided wake-up craniotomy for left temporal cavernous haemangioma.
Case report: A 45-year-old woman was admitted after an acute episode of vertigo and headache preceded fall with facial trauma. Computed tomography of the brain showed recent left temporal haemorrhage. Functional magnetic resonance imaging confirmed the cause of bleeding to be a highly vascular lesion, radiologically compatible with cavernous haemangioma, medial to arcuate fasciculus. A neuronavigation-guided sleep-awake-sleep craniotomy with complete surgical resection of abnormal tissue ensued. No immediate and long-term postoperative neurological deficits were noted. Final pathology report confirmed the diagnosis of cavernoma.
Discussion: By providing intraoperative monitoring of eloquent areas, awake excision of tumour or seizure focus can be more extensive without functional compromise. We propose a broadening of existing indications for wake-up craniotomy, as our case illustrates its value in context of a successful cavernomous hemangioma resection.
Conclusion: Wake-up craniotomy is an asset to neuronavigation-guided procedures in functional brain areas. We report its merit in a safe and extensive surgery for left temporal cavernoma.
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