{"id":"e6f9e2bd-8996-4436-a3fe-419bdf1d97e2","slug":"successful-excision-of-a-pontomesencephalic-cavernoma-through-anterior-subtemporal-route-without-mapping-anatomical-landmarks-as-a-road-map","title":"Successful excision of a pontomesencephalic cavernoma through anterior subtemporal route without mapping: Anatomical landmarks as a road map","authors":["Pravin Salunke","Sushant Sahoo","Sameer Futane"],"abstract":"Background: Brain stem cavernomas account for 9-35% of total intracerebral cavernomatous malformations, with pediatric cases being particularly rare. The surgical excision of pontomesencephalic cavernomas poses unique challenges due to their proximity to critical neural structures. Successful total excision is associated with favorable outcomes, particularly when performed without damaging the nuclei or long tracts. Methods: A 14-year-old male with a large pontomesencephalic cavernoma underwent surgery via an anterior subtemporal transtentorial approach without navigation or mapping. The procedure involved incising the tent posterior to the trochlear nerve, allowing access to the cavernoma, which was excised completely using careful techniques to avoid injury to surrounding structures. Results: Postoperative histopathology confirmed the diagnosis of cavernoma. The patient experienced significant improvement in bilateral ptosis and right hemiparesis, with minimal hand weakness remaining after two months. Follow-up MRI demonstrated complete removal of the lesion, indicating successful surgical intervention. Conclusion: The anterior subtemporal transtentorial approach provides excellent visualization and access for the excision of large pontomesencephalic cavernomas, even in the absence of navigation tools. Understanding anatomical landmarks is crucial for preventing damage to vital structures during surgery. Keywords: cavernoma, brain stem, surgery, pediatric, pontomesencephalic, anatomical landmarks, subtemporal approach","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/e6f9e2bd-8996-4436-a3fe-419bdf1d97e2/featured/hero-1782421009711.png","publishDate":"2014-01-29T00:00:00.000Z","doi":"10.4103/2152-7806.126044","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/e6f9e2bd-8996-4436-a3fe-419bdf1d97e2/pdf"}