Combined telovelar-minimal transvermian approach for a bleeding pontine cavernoma in a 48-year-old patient

Abstract

Symptomatic pontine cavernous malformations carry a high risk of recurrent bleeding, which may result in permanent neurological deficit. Such lesions require surgical management that can be challenging to the neurosurgeon due to their anatomical location and their proximity to delicate neural structures. An ideal surgical approach should provide maximal surgical resection with minimal morbidity. We present the case of a 48-year-old woman with a pontine cavernoma with repeated spontaneous intralesional hemorrhages, resected using a telovelar approach extended by a minimal incision of the inferior vermis, with good surgical outcome. The telovelar approach provided a good access to the lateral recesses and the foramen of Luschka, while the lower vermian incision provided a greater vertical working angle inside the ventricle.

Keywords

• cavernous malformation
• brainstem
• suboccipital
• telovelar
• transvermian
• motor evoked potentials