Pediatric Pontine Cavernous Malformations: The Presigmoid, Posterior Petrosal Approach.

BACKGROUND

Brainstem cavernous malformations (cavernomas) in children have a high risk of hemorrhage and neurological deterioration. This risk is magnified if the child has a genetic predisposition for cavernoma formation. The surgical management is challenging and carries a significant risk of morbidity.

OBJECTIVE

To describe the feasibility of a posterior petrosal approach to brainstem cavernomas in a pediatric population.

METHODS

A single institution operative experience with this technique was reviewed; 2 cases were identified and are technically described here with supportive figures and illustrations, as well as a focused literature review.

RESULTS

Two pediatric cases with multiple symptomatic hemorrhages from large expanding pontine cavernomas were identified. Both cavernomas were resected through a presigmoid posterior petrosal approach. While this approach is well described in the adult literature for ventral brainstem lesions, its description for the treatment of pontine cavernomas in the pediatric populations is scarce.

CONCLUSION

This study demonstrates the utility and feasibility of the posterior petrosal approach in two pediatric patients at different points in cranial base development.