Pontine cavernous angioma resected using the subtemporal, anterior transpetrosal approach determined using three-dimensional anisotropy contrast imaging: technical case report.

Abstract

We describe a case of brainstem cavernous angioma resected by the subtemporal, anterior transpetrosal approach, selected on the basis of three-dimensional anisotropy contrast (3-DAC) imaging. A 64-year-old woman presented with sudden headache and gait disturbance. Anatomic magnetic resonance imaging showed a mass lesion in the left anterolateral part of the pons. On 3-DAC imaging, posteromedial compression of the left corticospinal and corticopontine tracts by the mass lesion was demonstrated. The lesion was resected through the anterolateral side of the pons via the subtemporal, anterior transpetrosal approach. Neurological symptoms improved postoperatively, and postoperative 3-DAC imaging demonstrated preservation of the corticospinal and corticopontine tracts. The technique of 3-DAC imaging may provide important information regarding neural tracts for the planning of brainstem surgery.