Sub-telo-velo-tonsillar approach to resect dorsal pons cavernoma through fourth ventricular floor opening: how I do it

• Published in: Acta neurochirurgica Vol. 163; no. 6; pp. 1757 - 1761
• Main Authors: Bonasia, Sara, De Trizio, I., Valci, L., Robert, T.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.06.2021; Springer Nature B.V
• Subjects: Brain stem; How I Do it - Vascular Neurosurgery - Other; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurological diseases; Neurology; Neuroradiology; Neurosurgery; Pons; Surgical Orthopedics; Surgical techniques; Tonsil; Vascular Neurosurgery – Other; Ventricle; Ventricles (cerebral); Fourth ventricle; Telo-velar approach; Brainstem; Cavernoma
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-020-04503-6

Background Dorsal pons cavernoma can be approached through telo-velar approach instead of transvermian approach, with lower risk of neurological deficits since it uses natural clefts to reach the floor of the fourth ventricle. Materials and methods We present our surgical technique for telo-velar approach to address pathologies of the dorsal pons, assisted by neuronavigation and neuromonitoring. This surgical technique is illustrated by a surgical video of a dorsal pons cavernoma. Conclusion Dorsal pons cavernomas can be reached through telo-velar approach after suboccipital midline craniotomy. The accurate patient positioning, cisternal dissection, and neuromonitoring use are mandatory to avoid neural injuries and identify the safe entry points into the brainstem.