Microsurgical Resection of a Ventral Pontine Cavernoma via Supratrigeminal Zone by Anterior Transpetrosal Approach: 2-Dimensional Operative Video

Operative Neurosurgery
Kunio YokoyamaMasashi Yamshita

Abstract

Brainstem cavernomas with recurrent bleeding and gradual neurological deterioration should be considered an indication for surgical treatment. However, surgery is challenging for cavernous hemangiomas located in the ventral part of the pons. In such cases, safe surgical access to the brainstem is limited and obtaining a good surgical field, regardless of the approach selected, is often difficult. Here, we show a 73-year-old man with a history of 3 episodes of intracranial bleeding associated with a cavernous hemangioma located in the right ventral pons. The hemangioma was removed via the supratrigeminal zone of the brainstem using an anterior transpetrosal approach (ATPA). ATPA was first described in 1985 for upper petroclival lesions by Kawase T.1 This approach requires epidural subtemporal procedures to expose the petrous apex adequately. The petrous apex must be totally resected and the dura of the temporal lobe and posterior fossa is then cut to ligate the superior petrosal sinus and tentorium. In this procedure, the most important things are to preserve the internal carotid artery (C2 segment) and greater superficial petrosal nerve (GSPN). To identify the GSPN, facial nerve integrity monitor (Medtronic Inc, Dublin, Ireland...Continue Reading

References

Dec 1, 1985·Journal of Neurosurgery·T KawaseT Mine
Oct 10, 2015·Journal of Neurosurgery·Daniel D CavalcantiRobert F Spetzler

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Citations

Jun 21, 2020·Acta neurochirurgica·Walter C Jean, Gregory L Davis

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