Lateral supracerebellar infratentorial approach for pontomesencephalic cavernous malformations

Karl R Abi-Aad; Devi P Patra; Matthew E Welz; Evelyn Turcotte; Bernard R Bendok

doi:10.3171/2019.7.FocusVid.191227

Lateral supracerebellar infratentorial approach for pontomesencephalic cavernous malformations

Neurosurg Focus Video. 2019 Jul 1;1(1):V29. doi: 10.3171/2019.7.FocusVid.191227. eCollection 2019 Jul.

Authors

Karl R Abi-Aad^{1

2

3}, Devi P Patra^{1

2

3}, Matthew E Welz^{1

2

3}, Evelyn Turcotte^{1

2

3}, Bernard R Bendok

Affiliations

¹ Departments of Neurological Surgery.
² Precision Neuro-therapeutics Innovation Lab, Mayo Clinic; and.
³ Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.

Abstract

Cavernomas at the posterolateral pontomesencephalic surface can be approached from a lateral infratentorial supracerebellar corridor. In this surgical video, we demonstrate two cases of brainstem cavernomas resected through a lateral supracerebellar infratentorial approach. A supine position with lateral turn of the head was used along with significant reverse Trendelenburg to allow the cerebellum to fall away with gravity from the tentorium. After exposure of the posterior surface of the brainstem between the tentorium and the superior cerebellar surface with aid of neuronavigation, the cavernomas were safely resected. The video can be found here: https://youtu.be/fUDdaprg26Y.

Keywords: brainstem cavernoma; lateral supracerebellar infratentorial; surgical anatomy; video.