Acta neurochirurgica
September 22, 2026 · via Europe PMC
The retrosigmoid trans-middle cerebellar peduncle approach for pontine cavernous malformations: multicenter experience.
Al-Afif S, Hermann EJ, Früh A, Oltmanns J, Woitzik J, Vajkoczy P, Krauss JK.
AI summary — for doctors, generated from the abstract only
In a 5-patient multicenter series, the retrosigmoid trans-middle cerebellar peduncle approach achieved gross total resection of deep pontine cavernous malformations with mostly transient morbidity and favorable outcomes.
What was studied
Multicenter retrospective case series from three academic centers of 5 patients (mean age 44.8) with symptomatic intrinsic pontine cavernous malformations resected via a retrosigmoid trans-MCP approach with neuromonitoring.
Key findings
- Gross total resection in 5/5
- Postoperative neurological morbidity in all 5, predominantly transient
- No residual or recurrence on MRI at 4-14 months
- Median mRS improved from 4 preoperatively to 1 at follow-up
Clinical relevance
This suggests the trans-MCP approach can be reproduced outside its originating center for selected pontine cavernous malformations, but the tiny series and short follow-up preclude firm conclusions.
Who should care
Limitations
Very small case series, short follow-up, and selected patients treated by experienced surgeons.
The trans-MCP corridor appears workable for deep pontine cavernomas in experienced hands, though temporary deficits are expected.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Intrinsic pontine cavernous malformations represent one of the most challenging entities in neurosurgery because of their deep location and close proximity to critical brainstem nuclei and long tracts. Traditional surgical approaches are associated with considerable morbidity due to transgression of eloquent neural tissue. The identification of the trans-middle cerebellar peduncle (trans-MCP) approach, has enabled safer access to selected pontine lesions. However, apart from publications of the center where the trans-MCP approach was introduced (Phoenix), little is known about its use and surgical outcome.
Methods
Patients with symptomatic intrinsic pontine cavernous malformations were treated via a retrosigmoid trans-MCP approach at three academic neurosurgical centers. Data were obtained from institutional databases and included clinical presentation, imaging characteristics, surgical details, and follow-up outcomes.
Results
Five patients (3 men, 2 women; mean age 44.8 years) were included. All lesions were intrinsically located within the pons without pial or ependymal surface presentation and demonstrated typical hemorrhage MRI characteristics with mass effect on adjacent structures. The median preoperative mRS was 4 (range 1-4), and recurrent hemorrhage before surgery occurred in 3/5 patients. The retrosigmoid trans-MCP approach was performed with neurophysiological monitoring. Gross total resection was achieved in all instances. Postoperative neurological morbidity occurred in all five patients but was predominantly transient. At follow-up (range 4-14 months), no residual or recurrent cavernous malformations were detected on MRI. Neurological status had improved in all cases. Residual symptoms were minor and included mild ataxia, facial hypesthesia, dysarthria, or vertigo. Functional outcomes were favorable, with a median follow-up mRS of 1 (range 1-2).
Conclusion
The retrosigmoid trans-MCP approach represents a relatively safe, effective, and reproducible surgical strategy for selected pontine cavernous malformations. When performed by experienced surgeons, this approach can be successfully implemented across specialized centers.
DOI
10.1007/s00701-026-07043-7
PMID
42776330
PMCID
PMC13601307
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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