The presigmoid approach to anterolateral pontine cavernomas. Clinical article.

Journal Article


Anterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative.


Clinical data were reviewed in 9 patients presenting with anterolateral pontine cavernomas between 1999 and 2007.


All patients were treated via a presigmoid approach, which provided a nearly perpendicular trajectory to the anterolateral pons. The brainstem was entered through a "safe zone" between the trigeminal nerve and the facial/vestibulocochlear nerve complex. Complete resection was achieved in all cases. No patient experienced recurrent events during follow-up (1-24 months). The patients' modified Rankin Scale score improved within 1 year of surgery (1.7 ± 0.4) compared with baseline (2.6 ± 0.2; p < 0.05). Only one patient experienced a new deficit (decreased hearing), which was corrected with a hearing aid.


The presigmoid approach is recommended for the resection of anterolateral pontine cavernomas. With this approach, the need for cerebellar retraction is nearly eliminated. The lateral "presigmoid" entry point creates a trajectory that allows complete resection of even deep lesions at this level, or anterior to the internal acoustic meatus.

Full Text

Duke Authors

Cited Authors

  • Hauck, EF; Barnett, SL; White, JA; Samson, D

Published Date

  • October 2010

Published In

Volume / Issue

  • 113 / 4

Start / End Page

  • 701 - 708

PubMed ID

  • 20302394

Pubmed Central ID

  • 20302394

Electronic International Standard Serial Number (EISSN)

  • 1933-0693

International Standard Serial Number (ISSN)

  • 0022-3085

Digital Object Identifier (DOI)

  • 10.3171/2010.1.jns08413


  • eng