Microsurgical Approaches and Strategies for the Resection of Brainstem Cavernous Angiomas

We reviewed eight patients presenting with brainstem cavernous angiomas for whom microsurgical approaches were employed. The lesions were located in the dorsal midbrain in two patients, dorsal pons in two patients, ventral pons in three patients, and dorsal medulla oblongata in one patient. Microsurgical resection was performed via the occipital transtentorial approach for the dorsal midbrain lesions, the telovelar approach for the dorsal pons and medulla oblongata lesions, and the posterior transpetrosal approach for the ventral pontine lesions. Post-operative neurological status was either unchanged or improved in all cases. Establishment of the surgical corridor and a wide viewing angle for the lesion is an essential strategy to safely excise the brainstem cavernous angiomas with functional preservation of the surrounding vital neural structures.