- Department of Neurosurgery of São José do Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
Correspondence Address:
Ricardo Lourenço Caramanti, Department of Neurosurgery of São José do Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil.
DOI:10.25259/SNI_495_2025
Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Ricardo Lourenço Caramanti1, Erica Antunes Effgen2, Raysa Moreira Aprigio1, Matheus Rodrigo Laurenti1, Feres Chaddad-Neto2. Telovelar approach for resection of a pons metastasis: Three-dimensional surgical video. 08-Aug-2025;16:334
How to cite this URL: Ricardo Lourenço Caramanti1, Erica Antunes Effgen2, Raysa Moreira Aprigio1, Matheus Rodrigo Laurenti1, Feres Chaddad-Neto2. Telovelar approach for resection of a pons metastasis: Three-dimensional surgical video. 08-Aug-2025;16:334. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13764
Date of Submission
15-May-2025
Date of Acceptance
11-Jul-2025
Date of Web Publication
08-Aug-2025
Abstract
Background: Although metastases are the most common type of brain tumors, only 3–7% of them affect the pons. Due to its rarity and the high surgical morbidity, most cases are treated with radiotherapy; however, in selected cases, surgery can bring benefits such as improving the mass effect, local control of the disease, and avoiding the high risk of late neurological deficits caused by the scatter of radiation in radiotherapy treatment.
Case Description: We present a 72-year-old female with a history of 3 weeks of progressive dizziness and a decrease in sensitivity. The physical examination had a positive Romberg test. The neurologic investigation was performed by magnetic resonance imaging, which showed a unique pontine tumor with peripheral contrast enhancement and a necrotic center. Brain stem tractography revealed lateral displacement of sensitive fibers, allowing a safe approach to the tumor through the floor of the fourth ventricle. A microsurgical resection through a telovelar approach was proposed. The patient showed no worsening of symptoms, and a postoperative MRI revealed complete lesion resection. Tumor biopsy confirms lung metastasis diagnosis.
Conclusion: In this three-dimensional video, the authors present step–by–step microsurgical techniques for performing a pontine metastasis resection using a telovelar approach. It is essential to emphasize that technical and anatomical knowledge, combined with adequate patient selection, are crucial for achieving optimal results in cases of brainstem metastases.
Keywords: Brain metastasis, Pons, Suboccipital craniotomy, Telovelar Approach
Video 1
Annotations
Video key moments:
00:07 – Case presentation 0:30 – Neuro-imaging findings 03:15 – Surgical key steps 6:55 – Disease background 7:34 – Clinical outcome.
Ethical approval:
The research/study approved by the Institutional Review Board at fundacao faculdade regional de medicina S J Rio Preto, number 7.469.434, dated March 27, 2025.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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