Pretemporal transcavernous transtentorial approach for right pontine cavernous malformation

Area of Science:

• Neurosurgery
• Vascular Neurology
• Neuroradiology

Background:

• Cavernous malformations (CMs) are vascular anomalies that can occur in the brainstem.
• Pontine CMs present unique surgical challenges due to their location.
• Acute neurological changes can indicate symptomatic CMs.

Purpose of the Study:

• To describe a surgical technique for gross-total removal of a ventrolateral pontine cavernous malformation.
• To evaluate the safety and efficacy of an expanded surgical corridor approach.

Main Methods:

• A 57-year-old male patient with acute mental status changes underwent diagnostic imaging.
• Brain CT and MRA identified a large pontine cavernous malformation.
• Surgical resection was performed using an approach involving opening Meckel's cave and cutting the tentorium.

Main Results:

• Gross-total removal of the pontine cavernous malformation was successfully achieved.
• The surgical approach provided a wider corridor for accessing the ventrolateral pons.
• The patient's presentation of acute mental status changes was addressed.

Conclusions:

• The described surgical approach, utilizing an expanded corridor via Meckel's cave and tentorial opening, is safe and effective for selected ventrolateral pontine CMs.
• This technique facilitates a midline attack on the pons, potentially aided by posterior clinoid process removal.
• Successful gross-total resection of complex brainstem vascular lesions is achievable with tailored surgical strategies.