title: Surgical Approach to Ponto-mesencephalic Cavernoma.
abstract: The surgical treatment of intrinsic brainstem lesions remains a major challenge. In this article we present the results of using an infratentorial-supracerebellar (ITSC) approach for the resection of intrinsic ponto-mesencephalic lesions.
  
  
  
  The authors reviewed the cases of 16 patients. In seven of them, a paramedian ITSC transcollicular approach was used to resect intrinsic mid-brain lesions, and in the other nine patients, an intermediate or lateral ITSC infra-trochlear approach was used for ponto-mesencephalic lesions.
  
  
  
  All 16 lesions were completely removed. There was no recurrence of bleeding during the follow-up period, and no mortality. In seven patients with mid-brain lesions, the preoperative ocular symptoms improved in three of them, and the neurological deficits - other than ocular symptoms improved - in five of them. The preoperative modified Rankin Scale score of 1.8 improved to 1.3 postoperatively. In nine patients with a ponto-mesencephalic lesion, the preoperative ocular symptoms improved in four of nine patients, and the neurological deficits other than ocular symptoms improved in five of them, while one patient exhibited venous infarction in a cerebellar hemisphere that caused neurological deterioration. The preoperative modified Rankin Scale score of 3.75 improved to 2.5 postoperatively in these patients.
  
  
  
  The ITSC transcollicular or infra-trochlear approach provide a wide operative entry zone and minimize the functional damage to the surrounding structures for access to ponto-mesencephalic lesions.
authors.affiliation: Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan. kaku@murakami.asahi-u.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Kaku
authors.affiliation: Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takei
authors.affiliation: Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Miyai
authors.affiliation: Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan.
authors.forename: Kentarou
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan.
authors.forename: Jouji
authors.initials: J
authors.lastname: Kokuzawa
mesh_terms: D020295:Brain Stem Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brainstem; Cavernous malformation; Infratentorial supracerebellar approach; Trochlear nerve