Description:

This soundless video of a right far-lateral approach for resection of a ventral brainstem lesion demonstrates the relevant anatomy and surgical windows between cranial nerves needed to complete the operation. The patient is a 29-year-old woman with a history of headaches who presented with a right hemiparesis and right face paresthesias. The stripping of tumor from cranial nerves VII/VIII and IX/X/XI and from the vertebral artery can be seen. The end of the video shows our view around the ventral pontomedullary junction to the contralateral side. In the immediate post-operative period, she exhibited transient nystagmus that rapidly improved and had no cranial nerve deficits. She was able to tolerate a general diet without difficulty. Her hemiparesis had also improved by discharge. Follow-up MRI  revealed a near-total resection. The final pathology was consistent with a neurenteric cyst. For further reading on this entity, please refer to the following article: Liu JK, Couldwell WT. Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases. Neurosurg Focus. Aug 15;19(2):E9 2005. Video courtesy of Robert G. Kellogg, MD; Ricardo B.V. Fontes, MD; Lorenzo F. Munoz, MD, FAANS; and Richard W. Byrne, MD, FAANS.