Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas.
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).


CONCLUSIONS
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.
François
Patrick
P
CHRU de Tours, Service de Neurochirurgie, Université François Rabelais, Tours, France. francois@med.univ-tours.fr
Ben Ismail
Mounir
M
Hamel
Olivier
O
Bataille
Benoit
B
Jan
Michel
M
Velut
Stephane
S
D000328:Adult; D000368:Aged; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D003392:Cranial Sinuses / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011149:Pons / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012886:Skull / Q000033:anatomy & histology / Q000601:surgery; D013702:Temporal Lobe / Q000033:anatomy & histology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult