The presigmoid approach to anterolateral pontine cavernomas. Clinical article.


Journal Article

OBJECT: 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. METHODS: Clinical data were reviewed in 9 patients presenting with anterolateral pontine cavernomas between 1999 and 2007. RESULTS: 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. CONCLUSIONS: 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

Digital Object Identifier (DOI)

  • 10.3171/2010.1.JNS08413


  • eng

Conference Location

  • United States