The pretemporal approach to anterolateral midbrain cavernous malformations

Daniel D Cavalcanti; Vance Fredrickson; Paulo Niemeyer Filho

doi:10.3171/2019.10.FocusVid.19435

The pretemporal approach to anterolateral midbrain cavernous malformations

Neurosurg Focus Video. 2019 Oct 1;1(2):V17. doi: 10.3171/2019.10.FocusVid.19435. eCollection 2019 Oct.

Authors

Daniel D Cavalcanti¹, Vance Fredrickson², Paulo Niemeyer Filho³

Affiliations

¹ Department of Departments of Neurosurgery and Radiology, New York University School of Medicine, New York, New York.
² Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; and.
³ Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Rio de Janeiro, Brazil.

Abstract

Operating on the anterolateral midbrain is challenging due to limited surgical freedom provided by classic approaches and restraints imposed by the basilar artery apex and branches, their perforators, and the oculomotor nerve (Abla et al., 2011; Bricolo and Turazzi, 1995; Cavalcanti et al., 2016). This video demonstrates the benefits provided by the pretemporal approach for resection of an anterolateral mesencephalic cavernous malformation (Chaddad-Neto et al., 2014; de Oliveira et al., 1995). Four steps are well demonstrated in the video: 1) section of temporal pole veins to the sphenoparietal sinus; 2) division of arachnoid attaching the oculomotor nerve to the tentorial edge and uncus; 3) releasing the arachnoid between the anterior choroidal artery and uncus; and 4) following the oculomotor nerve to its origin. The video can be found here: https://youtu.be/7ZuK-ewNo6w.

Keywords: brainstem; cavernous malformation; microsurgery; pretemporal approach; video.