The pretemporal approach to anterolateral midbrain cavernous malformations.

Daniel D Cavalcanti,Paulo Niemeyer Filho,Vance Fredrickson

doi:10.3171/2019.10.focusvid.19435

Abstract

Operating on the anterolateral midbrain is challenging due to limited surgical freedom provided by classic approaches and restraints imposed by the basilar artery apex and branches, their perforators, and the oculomotor nerve (Abla et al., 2011; Bricolo and Turazzi, 1995; Cavalcanti et al., 2016).This video demonstrates the benefits provided by the pretemporal approach for resection of an anterolateral mesencephalic cavernous malformation (Chaddad-Neto et al., 2014; de Oliveira et al., 1995). Four steps are well demonstrated in the video: 1) section of temporal pole veins to the sphenoparietal sinus; 2) division of arachnoid attaching the oculomotor nerve to the tentorial edge and uncus; 3) releasing the arachnoid between the anterior choroidal artery and uncus; and 4) following the oculomotor nerve to its origin.The video can be found here: https://youtu.be/7ZuK-ewNo6w.

Highlights

This is the history of a 52-year-old female with two acute episodes of right-side weakness, one in 2012 and one in 2014, and numbness in right arm and leg, as well as in the left hemiface and unsteadiness
A frontotemporal incision is carried out beginning in the superior edge of the zygomatic arch, curving anteriorly, close to the midpupillary line, ending just behind the hairline
Tracking down the oculomotor nerve to its origin takes us to the pontomesencephalic junction, just between the proximal segments of the SCA and PCA

Summary

Introduction

This is the history of a 52-year-old female with two acute episodes of right-side weakness, one in 2012 and one in 2014, and numbness in right arm and leg, as well as in the left hemiface and unsteadiness. KEYWORDS brainstem; cavernous malformation; microsurgery; pretemporal approach; video Preoperative MRI (0:53) show a large cavernous malformation in the left anterolateral midbrain, occupying both cerebral peduncle and tegmentum. The lesion abuts the pial plane of both the ambiens and crural cisterns.

Results

Conclusion