World Neurosurg
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Case Reports
The pterional transsylvian transtentorial approach to ventrolateral pontine cavernomas: indications and techniques.
The authors describe a pterional transsylvian transtentorial approach to the ventrolateral pons based on its clinical application to cavernomas. ⋯ Although a comprehensive comparison with other approaches needs a large patient volume and a prospective designed study, the pterional transsylvian transtentorial approach could be an alternative for ventrolateral pontine cavernomas. The principle for this approach to ventrolateral pontine cavernomas is that if the thinnest parenchyma layer over the cavernoma could be defined in the ipsilateral upper ventrolateral pons, facilitated by an oblique multiangled working space, cavernomas in even the entire ventrolateral pons could be removed.
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The anatomy of the skull base is extremely complex with an abundance of critical neurovascular bundles and their corresponding foramina as well as the insertions and origins of multiple masticatory and craniocervical muscles. These anatomic intricacies increase the difficulty of surgery within this area. ⋯ EEAs are important techniques in contemporary skull base surgery. Understanding the indications for and limitations of these approaches help to maximize outcomes.