Subtemporal transtentorial approach for resection of a pontomesencephalic cavernous malformation

Georgios A Zenonos; Samir Sur; Maximiliano Nuñez; David T Fernandes-Cabral; Jacques J Morcos

doi:10.3171/2019.10.FocusVid.19365

Subtemporal transtentorial approach for resection of a pontomesencephalic cavernous malformation

Neurosurg Focus Video. 2019 Oct 1;1(2):V10. doi: 10.3171/2019.10.FocusVid.19365. eCollection 2019 Oct.

Authors

Georgios A Zenonos¹, Samir Sur¹, Maximiliano Nuñez², David T Fernandes-Cabral², Jacques J Morcos¹

Affiliations

¹ Department of Neurological Surgery, University of Miami, Miami, Florida, and.
² Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Abstract

In this 3D video we review the case of a pontomesencephalic cavernous malformation in a 27-year-old woman who presented with hemiparesis and diplopia. The cavernous malformation was completely resected through a subtemporal transtentorial approach and an epitrigeminal brainstem entry zone, with a significant improvement in the patient's hemiparesis. The relevant anatomy is reviewed in detail through multiple anatomical brainstem dissection specimens, as well as high-definition fiber tractography images. The rationale for the approach is analyzed relative to other possible options, and a number of technical pearls are provided. The video can be found here: https://youtu.be/8EoIWL7XqAc.

Keywords: brainstem anatomy; cavernous malformation; safe entry zones; subtemporal transtentorial approach; video.