The presigmoid approach to anterolateral pontine cavernomas: Clinical article

Erik Friedrich Hauck, Samuel L. Barnett, Jonathan Ari White, Duke Samson

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)701-708
Number of pages8
JournalJournal of Neurosurgery
Volume113
Issue number4
DOIs
StatePublished - Oct 2010

Fingerprint

Pons
Vestibulocochlear Nerve
Trigeminal Nerve
Hearing Aids
Facial Nerve
Acoustics
Hearing
Brain Stem

Keywords

  • Brainstem cavernoma
  • Pontine cavernoma
  • Presigmoid approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The presigmoid approach to anterolateral pontine cavernomas : Clinical article. / Hauck, Erik Friedrich; Barnett, Samuel L.; White, Jonathan Ari; Samson, Duke.

In: Journal of Neurosurgery, Vol. 113, No. 4, 10.2010, p. 701-708.

Research output: Contribution to journalArticle

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abstract = "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.",
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N2 - 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.

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