Sima Sayyahmelli, MD, and Mustafa K. Başkaya, MD

Department of Neurological Surgery, University of Wisconsin–Madison School of Medicine and Public Health, Madison, Wisconsin


Abstract
Surgical resection of cavernous malformations involving the medulla oblongata can be more challenging than other brainstem locations. This is due to the presence of densely packed vital neural structures in the medulla oblongata.
In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.
The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.


**Intro music: "Daybreak" by Graeme Rosner

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