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Paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract in children: intraoperative MRI and functional neuronavigation-guided resection

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Abstract

Objectives

In this study, we investigated whether visualization of the pyramidal tract and intraoperative MRI combined with functional navigation was helpful in the resection of paraventricular or centrum ovale cavernous hemangioma in children.

Methods

Twelve patients with cavernous hemangioma located in the paraventricular area or in the centrum ovale adjacent to the pyramidal tract were prospectively enrolled in the study. The pyramidal tract of all patients was visualized preoperatively, and all patients underwent tailored craniotomy with white matter trajectory to resect the lesion, with the help of intraoperative MRI and microscope-based functional neuronavigation.

Results

In our study, of the total of 12 patients (nine males and three females), five patients had lesions on the left side, and seven had lesions located in the right hemisphere. The lesion volume varied from 0.2 to 11.45 cm3. In seven cases, the distance of the lesion from the pyramidal tract was 0–5 mm (the 0–5 mm group), and five cases were in the 5–10 mm group. The 3D visualization of the lesion and the pyramidal tract helped the surgeon design the optimal surgical approach and trajectory. Intraoperative functional neuronavigation allowed them to obtain access to the lesion accurately and precisely. All lesions had been removed totally at the end of the surgery. Compared with the preoperative level, muscle strength at 2 weeks had decreased in six cases, was unchanged in four cases, and improved in two cases; at 3 months, it was improved in five cases, unchanged in six cases, and decreased in one case.

Conclusions

Pyramidal tract visualization and intraoperative MRI combined with functional neuronavigation can aid in safe removal of paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract.

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Acknowledgments

This work was supported by National Natural Science Foundation of China (81271515), Technological Innovation foundation of The PLA General Hospital (14KMM37), and Medical and Technical Innovation Project, Sanya, Hainan Province (2014YW31).

Conflict of interest

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Beijing, 100853, China

    Guo-chen Sun, Xiao-lei Chen, Xin-guang Yu & Bai-nan Xu

  2. Department of Radiology, PLA General Hospital, Beijing, China

    Gang Liu

Authors
  1. Guo-chen Sun
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  2. Xiao-lei Chen
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  3. Xin-guang Yu
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  4. Gang Liu
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Correspondence to Bai-nan Xu.

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Sun, Gc., Chen, Xl., Yu, Xg. et al. Paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract in children: intraoperative MRI and functional neuronavigation-guided resection. Childs Nerv Syst 31, 1097–1102 (2015). https://doi.org/10.1007/s00381-015-2672-z

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  • DOI: https://doi.org/10.1007/s00381-015-2672-z

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