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Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas

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Abstract

Objective

Pontine cavernomas are benign vascular lesions whose surgical treatment is challenging due to their localization. We report our experience in the surgical management of these lesions exclusively using a lateral, subtemporal transtentorial approach in high pontine lesions and an anterior petrosal approach in low pontine lesions.

Methods

We performed a retrospective study on a series of patients who were operated on for a pontine cavernoma in our neurosurgery department between 1987 and 2007. In the study, we detail the patients' clinical and preoperative radiological data and compare the two surgical techniques we used. Finally, we analyze the postoperative follow-up, the morbidity encountered according to the surgical approach used, and the long-term outcomes.

Results

We enrolled nine patients into the study. Six patients were operated on using an anterior petrosal approach. None of the patients died. Five patients were able to resume their former professional activity after surgery and were clearly improved following surgery. One patient was worse after surgery (hemiplegia and deafness). We used a subtemporal transtentorial approach in three of the patients. None of the patients died. Two of the patients were able to resume their prior professional activities without any sequels, and the third patient's condition worsened following surgery (temporal hematoma).

Conclusion

The lateral surgical approach for pontine cavernomas constitutes a reasonable surgical alternative to the transventricular, suboccipital, retromastoid, or transclival approaches. Patient morbidity in both approaches is acceptable, and the long-term outcome is satisfactory with respect to sequels and the resumption of prior professional activity.

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Authors and Affiliations

  1. CHRU de Tours, Service de Neurochirurgie, Université François Rabelais, Tours, France

    Patrick François, Mounir Ben Ismail, Michel Jan & Stephane Velut

  2. CHRU de Nantes, Service de Neurochirurgie, Nantes, France

    Olivier Hamel

  3. CHRU de Poitiers, Service de Neurochirurgie, Poitiers, France

    Benoit Bataille

  4. Laboratoire d’Anatomie, Université François Rabelais de Tours, Tours, France

    Stephane Velut

  5. Department of Neurosurgery, François Rabelais University, 10 Boulevard Tonnellé, 37044, Tours, France

    Patrick François

Authors
  1. Patrick François
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  2. Mounir Ben Ismail
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  3. Olivier Hamel
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  4. Benoit Bataille
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  5. Michel Jan
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Correspondence to Patrick François.

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Comments

The authors describe the use of the subtemporal transtentorial and anterior petrosectomy approaches to pontine cavernomas in nine patients treated at their institution over a 20-year period. Six patients were operated upon using the anterior transpetrosal approach; three underwent the subtemporal transtentorial approach. They achieved reasonable outcomes for patients in the series. The points that the authors make are valid regarding the discussion of the advantage of these approaches.

They provide a nice discussion of the alternative approaches (trans fourth ventricle: suboccipital and anterior transclival) to these pontine lesions. They describe their indications for both the subtemporal transtentorial and the anterior transpetrosal approach.

For many of the mid to lower lesions of the pons (such as in Fig. 2), many surgeons would alternatively choose a retrosigmoid or posterior petrosal approach. I have also personally used a far-lateral transcondylar approach to a lesion in the anterior and most inferior belly of the pons, which enables nice access from an inferior to superior trajectory in between the sixth nerves as the exit the pons.

The authors are to be commended for their nice description of the use of these approaches to this difficult anatomical area.

W.T. Couldwell

Utah, USA

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François, P., Ben Ismail, M., Hamel, O. et al. Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas. Acta Neurochir 152, 1321–1329 (2010). https://doi.org/10.1007/s00701-010-0667-9

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  • DOI: https://doi.org/10.1007/s00701-010-0667-9

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