• Erik Friedrich Hauck, Samuel L Barnett, Jonathan Ari White, and Duke Samson.
• Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA. erik.hauck@utsouthwestern.edu
• J. Neurosurg. 2010 Oct 1; 113 (4): 701-8.

ObjectAnterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative.MethodsClinical data were reviewed in 9 patients presenting with anterolateral pontine cavernomas between 1999 and 2007.ResultsAll patients were treated via a presigmoid approach, which provided a nearly perpendicular trajectory to the anterolateral pons. The brainstem was entered through a "safe zone" between the trigeminal nerve and the facial/vestibulocochlear nerve complex. Complete resection was achieved in all cases. No patient experienced recurrent events during follow-up (1-24 months). The patients' modified Rankin Scale score improved within 1 year of surgery (1.7 ± 0.4) compared with baseline (2.6 ± 0.2; p < 0.05). Only one patient experienced a new deficit (decreased hearing), which was corrected with a hearing aid.ConclusionsThe presigmoid approach is recommended for the resection of anterolateral pontine cavernomas. With this approach, the need for cerebellar retraction is nearly eliminated. The lateral "presigmoid" entry point creates a trajectory that allows complete resection of even deep lesions at this level, or anterior to the internal acoustic meatus.

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