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Retrosigmoid Transmiddle Cerebellar Peduncle Approach for Resection of a Giant Pontine Cavernous Malformation: 2-Dimensional Operative Video.
Oper Neurosurg (Hagerstown)
August 2024
Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa , Oklahoma , USA.
Objective: In the authors' microsurgical experience, the trans-middle cerebellar peduncle (MCP) approach to the lateral and central pons has been the most common approach to brainstem cavernous malformations (BSCMs). This approach through a well-tolerated safe entry zone (SEZ) allows a wide vertical or posterior trajectory, reaching pontine lesions extending into the midbrain, medulla, and pontine tegmentum. Better understanding of the relationships among lesion location, surgical trajectory, and long-term clinical outcomes could determine areas of safe passage.
View Article and Find Full Text PDFObjective: Brainstem cavernous malformations (BSCMs) are complex, difficult to access, and highly variable in size, shape, and position. The authors have proposed a novel taxonomy for pontine cavernous malformations (CMs) based upon clinical presentation (syndromes) and anatomical location (findings on MRI).
Methods: The proposed taxonomy was applied to a 30-year (1990-2019), 2-surgeon experience.
The far lateral transpontomedullary sulcus approach to pontine cavernous malformations: technical report and surgical results.
Neurosurgery
September 2014
Department of Neurological Surgery, Center for Cerebrovascular Research, University of California, San Francisco, California.
Background: Pontine cavernous malformations (CMs) located on a peripheral pontine surface or the fourth ventricular floor are resectable lesions, but those deep within the pons away from a pial surface are typically observed. However, the anterior bulge of the pons formed by the brachium pontis creates a unique entry point for access to deep pontine lesions from below, working upward through the pontomedullary sulcus.
Objective: We developed a transpontomedullary sulcus (TPMS) approach to these lesions.
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