The suboccipital, telovelar, transsuperior fovea approach to dorsal pontine lesions.

M Yashar S Kalani,Kaan Yağmurlu,Nikolay L Martirosyan,Robert F Spetzler

doi:10.3171/2019.7.focusvid.1927

Abstract

Dorsal pons lesions at the facial colliculus level can be accessed with a suboccipital telovelar (SOTV) approach using the superior fovea safe entry zone. Opening the telovelar junction allows visualization of the dorsal pons and lateral entry at the level of the fourth ventricle floor. Typically, a lateral entry into the floor of the fourth ventricle is better tolerated than a midline opening. This video demonstrates the use of the SOTV approach to remove a cavernous malformation at the level of the facial colliculus. This case is particularly interesting because of a large venous anomaly and several telangiectasias in the pons. Dissections in the video are reproduced with permission from the Rhoton Collection (http://rhoton.ineurodb.org).The video can be found here: https://youtu.be/LqzCfN2J3lY.

Highlights

Dorsal pons lesions at the facial colliculus level can be accessed with a suboccipital telovelar (SOTV) approach using the superior fovea safe entry zone
This case is a suboccipital telovelar approach used for resection of a dorsal pontine cavernous malformation
This 24-year-old female presented with left facial droop, facial numbness, gait difficulties, and a history of several bleeds caused by this pontine cavernous malformation located in the dorsal brainstem

Summary

Introduction

Dorsal pons lesions at the facial colliculus level can be accessed with a suboccipital telovelar (SOTV) approach using the superior fovea safe entry zone. This case is a suboccipital telovelar approach used for resection of a dorsal pontine cavernous malformation. The magnetic resonance imaging demonstrates the classic appearance of a cavernous malformation located eccentric to the left side in the dorsal pons with significant telangiectasias present throughout the pons as well as a large developmental venous anomaly. We elected to approach this lesion using a midline suboccipital craniotomy and a telovelar extension to resect the cavernous malformation.

Results

Conclusion