Transmastoid presigmoid retrolabyrinthine approach for removal of pontine cavernous malformation: how I do it

Background: Bleeding of brainstem cavernous malformations (BSCM) cause high morbidity and should be treated surgically whenever possible. Method: We present a 56-year-old man, who was diagnosed with a BSCM at right pons, which caused functional impairments of dorsal column, spinothalamic tract, cochlear nucleus, and middle cerebellar peduncle. A transmastoid presigmoid retorlabyrinthine approach via the lateral pontine zone (LPZ), with an assistance of imaging guidance and intraoperative neurophysiological monitoring, was performed to completely resect the BSCM. The patient recovered despite a transient worsening of cerebellar sign and hemiparesthesia for 1 week, without surgical complications. Conclusions: A transmastoid presigmoid retrolabyrinthine approach through LPZ is safe and effective for lateral pontine BSCM resection.