The surgical outcomes and nuances of the telovelar approach for pontine and medullary cavernous malformations: A multi-institutional case series

Background: Brainstem cavernous malformations (CMs) are characterized by dilated sinusoidal channels related to capillary telangiectasia and developmental venous anomalies. Brainstem CM hemorrhages present with focal neurological symptoms, according to their invasive lesions. Surgical removal should be considered for symptomatic and recurrent bleeding of brainstem CMs. Despite the risk of surgery with highly eloquent tissue, surgical removal should be performed to protect patients from stepwise decline due to recurrent hemorrhage. The approaches for treating brainstem CMs are retrosigmoid, far lateral, midline suboccipital with or without telovelar, orbitozygomatic, and supracerebellar-infratentorial. Pontine and medullary CMs are approached via retrosigmoid, far lateral, and suboccipital craniotomies, with or without the telovelar approach. Materials and Methods: The telovelar approach is the standard approach used for pontine brain-stem CMs. Patients with brainstem CMs treated using the telovelar approach were enrolled from three institutions. Results: All three patients had no further neurological deficits after surgery. Conclusions: The surgical results suggest that the telovelar approach for pons and pontomedul-lary junction brainstem CMs is safe and effective.