Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions.

Area of Science:

• Neurosurgery
• Microsurgery
• Neuroanatomy

Background:

• Ventral intrinsic pontomedullary lesions pose significant surgical challenges.
• Effective management requires precise surgical techniques and anatomical understanding.

Purpose of the Study:

• To describe a simple, safe, and reliable microsurgical protocol for ventral pontomedullary lesions.
• To detail the use of retrosigmoid approach and safe entry zones for resection.

Main Methods:

• Prospective study of 11 patients with ventral intrinsic pontomedullary lesions.
• Utilized retrosigmoid craniotomy, cortectomy via safe entry zones (peritrigeminal/olivary areas), and microsurgical resection.
• Employed neuronavigation and electrophysiological monitoring for intraoperative guidance.

Main Results:

• Resected six pontine, two medullary, and six pontomedullary lesions (8 cavernomas, 3 tumors).
• Achieved 90.1% improvement in affected cranial nerves and 72.3% recovery of pathway symptoms.
• All patients reported satisfaction with the procedure and outcomes.

Conclusions:

• Radical resection of ventral intrinsic pontomedullary lesions is reliable with simple microsurgical procedures.
• Anatomical references are crucial for intraoperative decision-making.
• The described protocol offers a safe and effective approach with good clinical results.