Lateral supracerebellar infratentorial approach for pontomesencephalic cavernous malformations.

Karl R Abi-Aad,Devi P Patra,Matthew E Welz,Evelyn Turcotte,Bernard R Bendok

doi:10.3171/2019.7.focusvid.191227

Abstract

Cavernomas at the posterolateral pontomesencephalic surface can be approached from a lateral infratentorial supracerebellar corridor. In this surgical video, we demonstrate two cases of brainstem cavernomas resected through a lateral supracerebellar infratentorial approach. A supine position with lateral turn of the head was used along with significant reverse Trendelenburg to allow the cerebellum to fall away with gravity from the tentorium. After exposure of the posterior surface of the brainstem between the tentorium and the superior cerebellar surface with aid of neuronavigation, the cavernomas were safely resected.The video can be found here: https://youtu.be/fUDdaprg26Y.

Highlights

Departments of 1Neurological Surgery, 2Otolaryngology, and 3Radiology, Mayo Clinic; 4Precision Neuro-therapeutics Innovation Lab, Mayo Clinic; and 5Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
We demonstrate two cases of brainstem cavernomas resected through a lateral supracerebellar infratentorial approach
The two approaches that can be considered for this lesion are a lateral supracerebellar infratentorial approach or a subtemporal approach

Summary

Introduction

Departments of 1Neurological Surgery, 2Otolaryngology, and 3Radiology, Mayo Clinic; 4Precision Neuro-therapeutics Innovation Lab, Mayo Clinic; and 5Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona. Cavernomas at the posterolateral pontomesencephalic surface can be approached from a lateral infratentorial supracerebellar corridor. We demonstrate two cases of brainstem cavernomas resected through a lateral supracerebellar infratentorial approach.

Results

Conclusion