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The surgical outcomes and nuances of the telovelar approach for pontine and medullary cavernous malformations: A multi-institutional case series
J Korean Skull Base Soc 2023;18(2):75-84
Published online October 31, 2023
© 2023 Korean Skull Base Society.

Inseo Hong1, Kyung Hwan Kim1, Huyk-Jin Oh2, Sae Min Kwon3, Hee-Won Jeong1, Eun-Oh Jung1, Han-Joo Lee1, Hyon-Jo Kwon1, Seung-Won Choi1, Seon-Hwan Kim1, Hyeon-Song Koh1, Jin-Young Youm1

1Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
2Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
3Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
Correspondence to: Kyung Hwan Kim
Received June 8, 2023; Revised July 7, 2023; Accepted July 10, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 brainstem 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 pontomedullary junction brainstem CMs is safe and effective.
Keywords : Cavernous hemangioma, Hemorrhage, Telovelar approach