title: Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation.
abstract: OBJECTIVE
  Brainstem cavernous malformations (BSCMs) present a unique therapeutic challenge to neurosurgeons. Resection of BSCMs is typically reserved for lesions that reach pial or ependymal surfaces. The current study investigates the lateral inferior cerebellar peduncle as a corridor to dorsolateral medullary BSCMs.
  
  
  METHODS
  In this retrospective review, the authors present the cases of 4 patients (3 women and 1 man) who had a symptomatic dorsolateral cavernous malformation with radiographic and clinical evidence of hemorrhage.
  
  
  RESULTS
  All patients underwent excision of the cavernous malformation via a far-lateral suboccipital craniotomy through the foramen of Luschka and with an incision in the inferior cerebellar peduncle. On intraoperative examination, 2 of the 4 patients had hemosiderin staining on the surface of the peduncle. All lesions were completely excised and all patients had a good or excellent outcome (modified Rankin Scale scores of 0 or 1).
  
  
  CONCLUSIONS
  This case series illustrates that intrinsic lesions of the dorsolateral medulla can be safely removed laterally through the foramen of Luschka and the inferior cerebellar peduncle.
authors: Department of Neurosurgery, Providence Brain and Spine Institute, Portland, Oregon; and.
authors: Vivek R
authors: VR
authors: Deshmukh
authors: Leonardo
authors: L
authors: Rangel-Castilla
authors: Robert F
authors: RF
authors: Spetzler
mesh_terms: D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013681:Tegmentum Mesencephali / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: BSCM = brainstem cavernous malformation; CN = cranial nerve; ICP = inferior cerebellar peduncle; cavernous malformation; dorsolateral medulla; inferior cerebellar peduncle; surgical technique