Resection of pontine cavernous malformations using anterior transpetrosal approach with a preauricular arc incision

Abstract

Objective To evaluate the surgical method and resection outcomes of cavernous malformations (CMs) using anterior transpetrosal approach with a preauricular arc incision. Methods From June 2011 to December 2015, 48 patients with pontine CMs underwent resection using anterior transpetrosal approach with a preauricular arc incision at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The patients' clinical date and surgical outcomes were retrospectively analyzed. Results Among the 48 patients, gross total resection (GTR) was achieved in 44 cases and subtotal resection was performed in the remaining 4 cases. No death occurred in this series. Two patients were reoperated on due to postoperative rebleeding. 48 patients were followed up for a mean of 28.3±8.2 months.All patients with preoperative facial nerve palsy and ocular dyskinesia recovered post surgery, and no new cases of facial nerve palsy were reported. Neurological deficits were improved in 34 patients after operations. Five patients experienced transient aphasia postoperatively. The symptoms of 11 patients remained unchanged following surgery. Three patients' neurological conditions deteriorated after surgery. Conclusions The anterior transpetrosal approach with a preauricular incision could provide adequate exposure for the surgical removal of pontine CMs. Resection through anterior lateral part of the brainstem might cause no serious neurological deficits and severe complications such as the facial nerve palsy could be avoided. Key words: Pons; Hemangioma, cavernous, central nervous system; Microsurgery; Anterior transpetrosal approach