Middle Cerebellar Pedunculotomy Approach as a Common Route of Removal for Pontine Cavernous Angiomas

Abstract

The principle of removal of brain stem cavernous angiomas (BSCA) is to enter the brain stem parenchyma through the point where the lesion appears near the surface. The midpontine lesion situated near the 4th ventricle floor has, therefore, mostly been operated through the incision over the 4th ventricle floor above or below the facial prominence. However, this approach actually carries a high risk of postoperative facial nerve dysfunction because of a limited allowance of retraction due to its upward angle of operative trajectory.
We introduce a new approach via subtemporal transpetrosal craniotomy with incision on the middle cerebellar peduncle for removal of a BSCA in the midpontine region.