Middle Cerebellar Peduncle Metastasis
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Here's a nice example, of resection of a deep seated metastasis within the middle cerebellar peduncle. This is a 62 year old female with a history of breast cancer and progressive imbalance, MRI evaluation. The axial one with contrast revealed a relatively homogeneously enhancing mass within the middle cerebellar peduncle with significant evidence of edema. Due to her progressive gait difficulty, she underwent resection via a left sided retro mastoid craniotomy. Transverse sinus, sigmoid sinus, opening of the dura. Next, the arachnoid bands were widely dissected within the cerebellopontine angle so that the cerebellum can be mobilized more immediately. Here's the seventh and eighth cranial nerves, fifth cranial nerves, the petrosals sinus. You can see the swelling within the middle cerebellar peduncle, small incision was made just over the metastasis. You can see the capsule of the tumor. Now the tumor is more evident. I attempted to de-bulk some of the tumor using pituitary Ron Jores. Tumor was quite firm, somewhat mascular. After some de-bulking, the tumor was circumferentially disconnected from the surrounding white matter. Here's mobilization of the tumor, more anteriorly and laterally. Good margins as expected for a metastatic lesion. You can see the counter traction on the white matter using the suction device, while the lesion is gently mobilized out of the resection cavity. Next, the lesion was removed piecemeal. Here's the larger piece. Hemostasis was secured. Here's another close look again. Pons and fifth cranial nerve, seven and eighth cranial nerve complex. The location or the resection cavity. Here's another de-magnified view. And the post-operative MRI at three months revealed gross total removal of the mass, and this patient's imbalance improved after surgery. Thank you.
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