Transpetrosal Approach for Pontine Cavernous Malformations

Abstract

Brainstem cavernous malformations account for 9 35 of all intracranial cavernous malformations and most brainstem cavernous malformations arise from the pons. Pontine cavernous malformations remain surgically challenging because of their deep seated and eloquent locations. Although several approaches have been reported to remove pontine cavernous malformations, there are only a few reports available regarding the transpetrosal approach in pontine cavernous malformation surgery. Here, we report our experience in treating patients with pontine cavernous malformations by the transpetrosal approach. Furthermore, alternate surgical approaches to pontine cavernous malformations will be discussed. A total of six cases were included in this study. There were four men and two women with an average age of 46.2 years. All cases presented neurological deficits caused by hemorrhage before surgery. The anterior transpetrosal approach was used in four and a combined transpetrosal approach was used in two cases. Gross total removal was achieved in all cases with an acceptable surgical outcome. We consider that a small cortical incision which allows multi direction dissection is the most important factor to avoid additional neurological deficits in cavernous malformation surgeries. Therefore, the transpetrosal approach can be used to minimize neurological deficits after removal of pontine lesions.