The brainstem is located at the base of the brain and is where the center of human life is located. It is considered to be the pivot of life. Because of its extremely important function and deep location, it used to be difficult to reach regardless of the surgical access and, because of the high surgical risk, it was often considered a surgical no-go area.
In recent years, transnasal endoscopy has been gradually adopted internationally to remove tumors in this area in a very minimally invasive manner, i.e., without craniotomy. Recently, we have been following the latest progress abroad, and with the cooperation of neurosurgery, we have used transnasal and ramp, to remove a huge cyst (about 5X4X3cm) at the brainstem. This technique is in the leading position in China. It is now presented.
Patient, female, 43 years old, from Jiangsu. She was admitted to the hospital for physical examination due to headache discomfort and was found to be located at the brainstem as a giant occupancy, which was initially determined to be a cystic mass by MRI scan. As shown in Figure 1. it can be seen that the tumor was located between the vertebrobasilar artery and the brainstem, compressing the brainstem and producing symptoms. After weighing the pros and cons, we used a transnasal approach, guided by navigation equipment, to remove the tumor. During the procedure, we successfully stopped the hemorrhage from the basal sinus by opening a window in the slope, avoiding the vertebrobasilar artery in front of the tumor on the surgical approach, and exposed and resected the tumor with the guidance of the navigation device. The tumor was seen to be a large, cheese-like cyst. The tumor is gradually removed. The opening at the skull base was then repaired with a nasal septal flap with a vascular tip. The postoperative pathology was reported as a neural tube protointestinal cyst, and the patient was discharged safely and quickly after aggressive treatment. As shown in Figure 4. the tumor was excised cleanly and the compression on the brainstem was released. This case is characterized by the use of a transnasal endoscopic transslope approach to remove the occupancy located in the posterior cranial fossa after a clear diagnosis and a one-stage repair of the skull base opening. This technique provides a new idea for the treatment of such unusually difficult patients.