Surgical management of pontine cavernous malformations: A focused review with case illustrations

Pontine cavernous malformations (CMs) represent one of the most surgically challenging forms of cerebral CMs due to their deep-seated location and proximity to critical neural structures. While observation may be appropriate in selected asymptomatic cases, recurrent hemorrhage or progressive neurological deterioration often requires surgical intervention. This review focuses on the microsurgical management of pontine CMs with emphasis on safe entry zones and approach selection. Two illustrative cases are presented to highlight decision-making and technical nuances: the first was approached via a subtemporal transtentorial route targeting the supratrigeminal zone, and the second via an anterior petrosal approach to the peritrigeminal zone. Gross total resection was achieved in both cases with favorable neurological outcomes. A comprehensive review of the literature is provided to contextualize indications, approach strategies, and postoperative outcomes. This focused review aims to support skull base surgeons in making informed decisions for these high-risk lesions.