The authors describe a safe entry zone, the superior fovea triangle, on the floor of the fourth ventricle for resection of deep dorsal pontine lesions at the level of the facial colliculus. Clinical data from a patient undergoing a suboccipital telovelar transsuperior fovea triangle approach to a deep pontine cavernous malformation were reviewed and supplemented with 6 formalin-fixed adult human brainstem and 2 silicone-injected adult human cadaveric heads using the fiber dissection technique to illustrate the utility of this novel safe entry zone. The superior fovea has a triangular shape that is an important landmark for the motor nucleus of the trigeminal, abducens, and facial nerves. The inferior half of the superior fovea triangle may be incised to remove deep dorsal pontine lesions through the floor of the fourth ventricle. The superior fovea triangle may be used as a safe entry zone for dorsally located lesions at the level of the facial colliculus.
Correspondence Robert F. Spetzler, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ 85013. email: email@example.com.
INCLUDE WHEN CITING Published online December 23, 2016; DOI: 10.3171/2016.8.JNS16947.
Drs. Yagmurlu and Kalani contributed equally to this work.
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
BertalanffyH, TissiraN, KrayenbühlN, BozinovO, SarntheinJ: Inter- and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle. 68:1 Suppl Operative23–31, 201121206320)| false
KyoshimaK, KobayashiS, GiboH, KuroyanagiT: A study of safe entry zones via the floor of the fourth ventricle for brainstem lesions. Report of three cases. 78:987–993, 1993848708510.3171/jns.1993.78.6.0987)| false
UlrichNHKockroRABellutDAmaxopoulouCBozinovOBurkhardtJK: Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients. Neurosurg Rev37:481–4922014
UlrichNH, KockroRA, BellutD, AmaxopoulouC, BozinovO, BurkhardtJK, : Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients. 37:481–492, 20142480172010.1007/s10143-014-0550-x)| false