Proposed operative approach in a critical area of the brain stem

Background and importance

The surgical approach to the medulla oblongata poses a significant challenge for neurosurgery, considering the clinical consequences and risks of this procedure. The authors describe a step-by-step technique to safely extirpate a cavernous malformation within the hypoglossal trigone with minimal risk of neurological deficits.

Clinical Presentation

In a young 33-year-old patient was identified a lesion in the center of the medulla oblongata. Complete resection of the cavernous malformation through the hypoglossal trigone was performed with an improvement of all symptoms. The key surgical tip is to dissect the lesion between the posterior median sulcus and the sulcus limitans avoiding the vagal trigone.

Conclusion

 Surgical approach through the hypoglossal trigone appears to be safe and effective for the treatment of medulla oblongata cavernomas. The entry zone through the dorsomedial sulcus of the hypoglossal trigone with a meticulous delicate microsurgical technique is the key to success with these kinds of lesions.