Interpeduncular Sulcus Approach to the Posterolateral Pons

Area of Science:

• Neurosurgery
• Neuroanatomy

Background:

• Posterolateral pontine lesions pose surgical challenges due to proximity to eloquent neural structures.
• Existing surgical approaches may have limitations in accessing this specific region.

Purpose of the Study:

• To describe a novel, safe surgical entry point for the posterolateral pons.
• To delineate the anatomical boundaries and dimensions of this safe entry zone.
• To evaluate its clinical applicability in treating pontine pathologies.

Main Methods:

• Literature review of pons anatomy and surgical approaches.
• Cadaveric dissection using fiber microdissection technique on human brainstems.
• Clinical correlation with a case of pontine astrocytoma.

Main Results:

• A safe entry zone within the interpeduncular sulcus was defined, measuring a mean of 8.2 mm.
• This zone extends from the caudal lateral mesencephalic sulcus to the trigeminal nerve crossing point.
• The approach is feasible via a paramedian infratentorial supracerebellar route, with options for cerebellar tissue removal.

Conclusions:

• The interpeduncular sulcus safe entry zone provides an alternative direct surgical corridor.
• It allows access to posterolateral pontine pathologies between the cerebellar peduncles.
• This approach minimizes contact with critical neural structures, potentially reducing surgical morbidity.