gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Telovelar approach neuro-navigation assisted to reach tumors located in the dorsal paramedian ponto-bulbar region

Meeting Abstract

  • corresponding author N. Francaviglia - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia
  • M. Maiello - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia
  • L. Pentimalli - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia
  • N. Alberio - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia
  • A. Morabito - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia
  • R. Lipani - U.O. di Neurochirurgia, Ospedale “S. Elia”, Caltanissetta, Italia

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 016

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Francaviglia et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Two relevant surgical routes to the fourth ventricle are the transvermian and the telovelar approaches. It is here reported our experience of two cases of dorsal paramedian ponto-bulbar lesions approached trough telovelar route assisted by neuronavigation.

Methods: Case 1: 27-year-old male, harbouring a cavernous hemangioma located paramedially and dorsally in the right ponto-bulbar region presenting with headache, vertigo and gait disorders.

Case 2: 69-year-old female harbouring a glioma of the right paramedian portion of the ponto-medullary region.

Clinical scenario was characterized by a progressively worsening right 6th, 7th and 9th nerves involvement.

In both patients the telovelar neuro-navigation assisted approach provided access through a “safe access zone”: the right infrafacial triangle to the paramedian region of the fourth ventricle floor. It was also possible to access the regions of the lateral and supero-lateral recesses, obex, striae medullaris, facial colliculus and calamus scriptorium.

Results: In case one a total lesion removal was obtained, while in case two a biopsy and subtotal resection of the lesion was feasible. In both cases no post-operative complications were appreciated. In case two a transitory postoperative worsening of the right 7th nerve paresis was appreciated.

Conclusions: Telovelar approach neuro- naviagation assisted offered an optimal surgical corridor through noneloquent arachnoid planes and a capacious working environment sparing splitting of the vermis.