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Pretemporal transcavernous transtentorial approach for left pontine glioma
Chih-Hsiang Liao1,2, Chun-Fu Lin3,4, Wei-Hsin Wang3
1Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung.
Abstract:
A 39-year-old man, who had a history of spinal myxopapillary ependymoma with cerebrospinal seeding status post twice operations and radiation therapy, presented with aggravating headaches, diplopia, dysphagia, and unsteady gait for 2 weeks. The brain MRI revealed a parenchymal lesion at the left aspect of the pons, about 2.8 × 2.3 × 3.2 cm3. The patient underwent a pretemporal transcavernous transtentorial approach for tumor removal. The pathological report showed an anaplastic astrocytoma. In this approach, a wider surgical corridor was obtained by opening the Meckel's cave and cutting the tentorium, via which a safe entry point into the pons could be determined with neuromonitoring. In the authors' opinion, this approach is safe and effective in selected ventrolateral pontine gliomas. The video can be found here: https://youtu.be/sUt-9QFGgCI.
Insights
A novel surgical approach provided safe and effective removal of a rare pontine glioma. This technique utilized a pretemporal transcavernous transtentorial route, enhancing surgical access for complex brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Neuropathology
Background:
- Recurrent or metastatic tumors in the brainstem present significant surgical challenges.
- Pontine gliomas require specialized surgical techniques for optimal resection and patient outcomes.
- Previous treatments for spinal myxopapillary ependymoma included surgery and radiation therapy.
Purpose of the Study:
- To evaluate the safety and efficacy of a pretemporal transcavernous transtentorial approach for resecting a ventrolateral pontine glioma.
- To describe the surgical technique and its advantages in accessing pontine lesions.
- To report a case of anaplastic astrocytoma in the pons.
Main Methods:
- A 39-year-old male patient with a history of spinal ependymoma underwent surgical resection of a pontine lesion.
- The surgical approach involved a pretemporal transcavernous transtentorial route, including opening Meckel's cave and cutting the tentorium.
- Intraoperative neuromonitoring was used to ensure a safe entry point into the pons.
Main Results:
- The surgical team successfully resected the pontine tumor using the described approach.
- Pathological examination confirmed the tumor as an anaplastic astrocytoma.
- The approach facilitated a wider surgical corridor, allowing for safe tumor removal.
Conclusions:
- The pretemporal transcavernous transtentorial approach is a viable and effective surgical option for selected ventrolateral pontine gliomas.
- This technique offers enhanced surgical access and safety for complex brainstem tumor resections.
- Further studies may explore the broader application of this approach in neurosurgical oncology.
