Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery

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• dc.contributor.author Agyemang, Kevin
• dc.contributor.author Gómez Rodríguez, Rony
• dc.contributor.author Rocha Marussi, Victor Hugo
• dc.contributor.author Marte Arias, Sally Allinson
• dc.contributor.author Vilcahuaman Paitań, Alexander Feliciano
• dc.contributor.author Campos Filho, José Maria
• dc.contributor.author Chaddad-Neto, Feres
• dc.date.accessioned 2024-03-06T06:58:26Z
• dc.date.available 2024-03-06T06:58:26Z
• dc.date.issued 2023
• dc.description.abstract Introduction: Developmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical "safe zones", intraoperative monitoring of long tracts and cranial nerve nuclei, and preservation of the DVA as key to avoiding complications in brainstem cavernoma microsurgery. Symptomatic outflow restriction of DVA is rare, with the few reported cases in the literature restricted to DVAs in the supratentorial compartment. Case: We present a case report of the resection of a pontine cavernoma complicated by delayed outflow obstruction of the associated DVA. A female patient in her 20's presented with progressive left-sided hemisensory disturbance and mild hemiparesis. MRI revealed two pontine cavernomas associated with interconnected DVA and hematoma. The symptomatic cavernoma was resected via the infrafacial corridor. Despite the preservation of the DVA, the patient developed delayed deterioration secondary to venous hemorrhagic infarction. We discuss the imaging and surgical anatomy pertinent to brainstem cavernoma surgery, as well as the literature exploring the management of symptomatic infratentorial DVA occlusion. Conclusion: Delayed symptomatic pontine venous congestive edema is extremely rare following cavernoma surgery. DVA outflow restriction from a post-operative cavity, intraoperative manipulation, and intrinsic hypercoagulability from COVID-10 infection are potential pathophysiological factors. Improved knowledge of DVAs, brainstem venous anatomy, and "safe entry zones" will further elucidate the etiology of and the efficacious treatment for this complication.
• dc.format.mimetype application/pdf
• dc.identifier.citation Agyemang K, Gómez Rodríguez R, Rocha Marussi VH, Marte Arias SA, Feliciano Vilcahuaman Paitań A, Campos Filho JM, Chaddad-Neto F. Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery. Front Neurol. 2023 Mar 14;14:1073366. DOI: 10.3389/fneur.2023.1073366
• dc.identifier.doi http://dx.doi.org/10.3389/fneur.2023.1073366
• dc.identifier.issn 1664-2295
• dc.identifier.uri http://hdl.handle.net/10230/59330
• dc.language.iso eng
• dc.publisher Frontiers
• dc.relation.ispartof Front Neurol. 2023 Mar 14;14:1073366
• dc.rights © 2023 Agyemang, Gómez Rodríguez, Rocha Marussi, Marte Arias, Feliciano Vilcahuaman Paitań, Campos Filho and Chaddad-Neto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (http://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Brainstem
• dc.subject.keyword Case report
• dc.subject.keyword Cavernous angioma
• dc.subject.keyword Cavernous malformation
• dc.subject.keyword Developmental venous anomaly
• dc.subject.keyword Spontaneous occlusion
• dc.title Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion