• Mina M Gerges, Saniya S Godil, Ashutosh Kacker, and Theodore H Schwartz.
• Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York.
• Oper Neurosurg (Hagerstown). 2020 Jul 1; 19 (1): E75-E81.

Background And ImportanceBrainstem lesions are challenging to manage, and surgical options have been controversial. Stereotactic radiosurgery (SRS) has been used for local control, but life-threatening toxicities from 0% to 9.5% have been reported. Several microsurgical approaches involving safe entry zones have been developed to optimize the exposure and minimize complications in different portions of the brainstem, but require extensive drilling and manipulation of neurovascular structures. With recent advancements, the endoscopic endonasal approach (EEA) can provide direct visualization of ventral brainstem. No case has been reported of EEA to remove a brainstem metastasis.Clinical PresentationWe present an illustrative case of a 68-yr-old female with metastatic colon cancer who presented with 2.8 × 2.7 × 2.1 cm (7.9 cm3) heterogeneously enhancing, right ventral pontine lesion with extensive edema. She underwent endoscopic endonasal transclival approach, and gross total resection of the lesion was achieved.ConclusionThe endoscopic approach may offer certain advantages for removal of ventral brainstem lesions, as it can provide direct visualization of important neurovascular structures, especially, if the lesion displaces the tracts and comes superficial to the pial surface.Copyright © 2019 by the Congress of Neurological Surgeons.

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