Pediatric Pontine Cavernous Malformations: The Presigmoid, Posterior Petrosal Approach

Charles G. Kulwin, Troy D. Payner, Rick Nelson, Laurie L. Ackerman, Daniel H. Fulkerson

Research output: Contribution to journalArticle


BACKGROUND: Brainstem cavernousmalformations (cavernomas) in children have a high risk of hemorrhage and neurological deterioration. This risk is magnified if the child has a genetic predisposition for cavernoma formation. The surgical management is challenging and carries a significant risk of morbidity. OBJECTIVE: To describe the feasibility of a posterior petrosal approach to brainstemcavernomas in a pediatric population. METHODS: A single institution operative experience with this technique was reviewed; 2 cases were identified and are technically described here with supportive figures and illustrations, as well as a focused literature review. RESULTS: Two pediatric cases with multiple symptomatic hemorrhages from large expanding pontine cavernomaswere identified. Both cavernomaswere resectedthrough a presigmoid posterior petrosal approach.While this approach is well described in the adult literature for ventral brainstem lesions, its description for the treatment of pontine cavernomas in the pediatric populations is scarce. CONCLUSION: This study demonstrates the utility and feasibility of the posterior petrosal approach in two pediatric patients at different points in cranial base development.

Original languageEnglish (US)
Pages (from-to)522-529
Number of pages8
JournalOperative Neurosurgery
Issue number5
StatePublished - Nov 1 2018


  • Brainstem
  • Cavernoma
  • Cavernous malformation
  • Pediatric
  • Pons

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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