Pretemporal transcavernous transtentorial approach for left pontine glioma

Chih-Hsiang Liao; Chun-Fu Lin; Wei-Hsin Wang; Jui-To Wang; Shao-Ching Chen; Sanford P C Hsu

doi:10.3171/2019.10.FocusVid.19422

Pretemporal transcavernous transtentorial approach for left pontine glioma

Neurosurg Focus Video. 2019 Oct 1;1(2):V22. doi: 10.3171/2019.10.FocusVid.19422. eCollection 2019 Oct.

Authors

Chih-Hsiang Liao^{1

2}, Chun-Fu Lin^{3

4}, Wei-Hsin Wang³, Jui-To Wang^{3

4}, Shao-Ching Chen^{3

4}, Sanford P C Hsu^{3

4}

Affiliations

¹ Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung.
² Institute of Medicine, Chung Shan Medical University, Taichung.
³ Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei; and.
⁴ School of Medicine, National Yang Ming University, Taipei, Taiwan.

Abstract

A 39-year-old man, who had a history of spinal myxopapillary ependymoma with cerebrospinal seeding status post twice operations and radiation therapy, presented with aggravating headaches, diplopia, dysphagia, and unsteady gait for 2 weeks. The brain MRI revealed a parenchymal lesion at the left aspect of the pons, about 2.8 × 2.3 × 3.2 cm³. The patient underwent a pretemporal transcavernous transtentorial approach for tumor removal. The pathological report showed an anaplastic astrocytoma. In this approach, a wider surgical corridor was obtained by opening the Meckel's cave and cutting the tentorium, via which a safe entry point into the pons could be determined with neuromonitoring. In the authors' opinion, this approach is safe and effective in selected ventrolateral pontine gliomas. The video can be found here: https://youtu.be/sUt-9QFGgCI.

Keywords: Meckel’s cave; pontine glioma; pretemporal; transcavernous; transtentorial; video.