Lateral transpetrosal approaches for brainstem cavernous malformations: tailoring the operative trajectory according to lesion location. Illustrative cases.

BACKGROUND

The authors propose a surgical strategy for the resection of lateral brainstem cavernous malformations (BSCMs) and demonstrate how the surgical corridor should be tailored according to lesion location.

OBSERVATIONS: Three consecutive patients with lateral BSCMs underwent microsurgical resection through transpetrosal approaches. Two pontine lesions were approached through the lateral pontine zone using a posterior transpetrosal approach, whereas one upper lateral midbrain lesion required a combined transpetrosal approach to obtain a steeper upward operative trajectory through the lateral mesencephalic sulcus. Gross-total resection was achieved in all patients without new permanent neurological deficits. The posterior transpetrosal approach provided adequate exposure for pontine lesions, whereas the combined transpetrosal approach offered a more favorable upward trajectory for the upper lateral midbrain lesion.

LESSONS: Lateral transpetrosal approaches provide effective surgical corridors for lateral BSCMs while minimizing transgression of eloquent brainstem pathways. Selection of the posterior or combined transpetrosal approach should be tailored according to the rostrocaudal location of the lesion and the required operative trajectory. https://thejns.org/doi/10.3171/CASE26717.