Retrosigmoid Transmiddle Cerebellar Peduncle Approach for Resection of a Giant Pontine Cavernous Malformation: 2-Dimensional Operative Video

Abstract

Pioneering work in defining brainstem safe entry zones and development of surgical techniques has made microsurgical removal of brainstem cavernous malformation possible.1,2 The middle cerebellar peduncle (MCP) is a robust route for access to deep-seated lesions within the pons. The peduncle can be accessed by splitting the petrosal fissure of the cerebellum to obtain a more direct view to the MCP through a retrosigmoid approach. The author presents a case of a female with a history of 3 bleeds attributable to a giant pontine cavernous malformation. The patient consented to the procedure. Given the aggressive natural history of deep cavernous malformations, especially in the year following a bleed, surgical removal was recommended. Step-by-step description of access to the MCP through splitting the petrosal fissure, and key steps for removal of a pontine cavernous malformation are described.