Posterior petrosectomy for resection of pontine cavernous malformation

Abstract

Cavernous malformations (CMs) are low-pressure, focal, vascular lesions that may occur within the brainstem and re-quire treatment, which can be a substantial challenge. Herein, we demonstrate the surgical resection of a hemorrhaged brainstem CM through a posterior petrosectomy approach. After dissection of the overlying vascular and meningeal structures, a safe entry zone into the brainstem is identified based on local anatomy and intraoperative neuronavigation. Small ultrasound probes can also be useful for obtaining real-time intraoperative feedback. The CM is internally debulked and resected in a piecemeal fashion through an opening smaller than the CM itself. As brainstem CMs are challenging lesions, knowledge of several surgical nuances and adoption of careful microsurgical techniques are requi-site for success. The video can be found here: https://youtu.be/szB6YpzkuCo.