American Association of Neurological Surgeons | Pretemporal transcavernous transtentorial approach for right pontine cavernous malformation @AANSNeurosurgery | Uploaded July 2019 | Updated October 2024, 1 day ago.
Xavier T. J. Hsu, MD,1 Chih-Hsiang Liao, MD,2,3 Chun-Fu Lin, MD,1,4 and Sanford P. C. Hsu, MD1,4

1Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei; 2Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung; 3Institute of Medicine, Chung Shan Medical University, Taichung; and 4School of Medicine, National Yang Ming University, Taipei, Taiwan

Abstract
A 57-year-old man presented with acute changes in mental status. Brain CT showed a high-density lesion at the pons. Brain MRA revealed a very slow-flow vascular lesion at the right aspect of the pons, about 3.9 × 3.0 × 3.0 cm3, compatible with a pontine cavernous malformation (CM). Gross-total removal was achieved. In this approach, a wider surgical corridor was obtained by opening the Meckel’s cave and cutting the tentorium. For a midline attack point on the pons, additional removal of the posterior clinoid process can meet the goal. In the authors’ opinion, this approach is safe and effective in selected ventrolateral pontine CMs.


**Intro music: "Daybreak" by Graeme Rosner