Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain / Vascular Case

Right occipital craniotomy for cavernous malformation

Cavernous malformation. 24 year old woman presents to ER 2 years prior with first time seizure

Description

Cavernous malformation. 24 year old woman presents to ER 2 years prior with first time seizure

Gallery

Images

Figure 1Images from initial CT (left) and CTA (right); apx. 2 years pre-Op. They show moderately sized intracerebral hemorrhage (ICH) in the right parieto
Figure 2Images from initial MRI brain; apx . 2 year pre-Op. T2 (left) and SWI (right) confirm ICH in right parieto
Figure 3Images from initial MRI brain; apx . 2 year
Figure 4Repeat CT head; performed apx . 6 months pre-op. Image shows new ICH at same right parieto
Figure 5Cerebral angiogram. AP (left) and lateral (right) projections of the left internal carotid artery injection. No vascular lesion is visualized.
Figure 6Cerebral angiogram. AP (left) and lateral (right) projections of the left vertebral artery
Figure 7Repeat MRI brain done apx
Figure 8CT head performed immediately preop
Figure 9Image showing patient positioning for surgery. Pt is on her stomach (prone) and head is held in a precision head-holder. Planned incision is marked on scalp; minimal clipping of hair also demonstrated. OR equipment in background.
Figure 10Image captured from surgical navigation system. Showing pre-operative planning of incision and approach to the lesion.
Figure 11Intraoperative photo showing the surface of the brain after craniotomy has been performed and dura mater has been opened. The surface of the cerebral cortex appears relatively normal.
Figure 12Intraoperative photo showing microdissection around the lesion. Surgical instrument is being used to dissect and retract lesion in resection cavity.
Figure 13Intraoperative image captured from surgical navigation system showing the link between the surgical microscope and the navigational work-station. Images show the approach to the lesion and roughly correlate with Figure 10.
Figure 15Intraoperative image demonstrating the resection cavity after the lesion has been removed.
Figure 16Photos taken at the completion of the procedure. Image on left shows the incision which has been closed with absorbable suture (dissolving stitches); the right lesion shows the surgical dressing that is applied over the incision.
Figure 18MRI brain acquired 3 months post-op. T2 (left) and SWI (right) images show complete resection of the lesion.
Figure 17CT head taken immediately postop. Shows expected changes due to surgery and demonstrates the bone opening used to approach the lesion (craniotomy).

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