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Anterior subtemporal approach for posterolateral brainstem cavernomas: report of ten cases

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Abstract

Background

The neuronavigation-assisted anterior subtemporal approach is proposed in this article as an alternative to surgery of posterolateral brainstem cavernomas. Brainstem cavernomas represent a neurosurgical challenge because of the high morbidity and mortality rate related to their surgical removal. Several nerve nuclei, ascending and descending fibers make this region at high risk of serious postoperative deficits.

Methods

Between 1998 and 2010, 24 patients underwent surgical removal of brainstem cavernomas in our institution. Ten of these patients presented a cavernous malformation in the posterolateral region of the brainstem and underwent surgical removal by means of a neuronavigation-assisted anterior subtemporal approach.

Results

Lesion removal was complete for all patients. There were no cases of surgery-related death. Neurological status improved or remained unchanged after surgery in all cases. All patients presented good outcomes at 12 to 154 months' follow-up (mean 70 months; GOS = 5 in 8/10 patients, 4 in 2/10 patients; mRS = 0–1 in all patients). Only one patient presented transient confusion, aphasia and seizures related to temporal lobe swelling, which resolved completely within a few days. One patient developed cranial nerve III palsy and left hemiparesis with gradual recovery.

Conclusions

This approach represents a valid alternative to the “more classical” approaches for the surgery of posterolateral cavernomas of the pontomesenchephalic junction reaching the tentorial incisura, reducing the risk of damaging the vein of Labbé, temporal lobe swelling, cerebellar swelling, ophtalmoparesis, fourth ventricle cranial nerve nuclei lesions. Skeletonization of sigmoidal sinus provides with good outcomes, low morbidity and mortality.

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Acknowledgments

The authors wish to thank Daniele Petricca for providing the figures.

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Authors and Affiliations

  1. Neurosurgery Institute Catholic University School of Medicine, Largo F.Vito, 00168, Rome, Italy

    Giovanni Sabatino, Luigi Rigante, Enrico Marchese, Alessio Albanese, Giuseppe Esposito, Gennaro Capone & Giulio Maira

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  1. Giovanni Sabatino
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  2. Luigi Rigante
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  3. Enrico Marchese
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  4. Alessio Albanese
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  5. Giuseppe Esposito
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  6. Gennaro Capone
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  7. Giulio Maira
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Corresponding author

Correspondence to Luigi Rigante.

Additional information

Giovanni Sabatino and Luigi Rigante both authors contributed equally

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Sabatino, G., Rigante, L., Marchese, E. et al. Anterior subtemporal approach for posterolateral brainstem cavernomas: report of ten cases. Acta Neurochir 154, 2009–2016 (2012). https://doi.org/10.1007/s00701-012-1496-9

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  • DOI: https://doi.org/10.1007/s00701-012-1496-9

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