Cerebellar quadrangular lobule resection for microsurgical treatment of a pontine cavernous malformation via the trans-middle cerebellar peduncle approach

We present the case of a 32-year-old right-handed male with acute headache and right-predominant tetraparesis. MRI revealed a hemorrhagic dorsolateral pontine cavernous malformation with a surrounding hemosiderin ring and compression of the fourth ventricle. A microsurgical resection was performed via supracerebellar infratentorial approach. A minimal resection of the cranial quadrangular lobule improved both craniocaudal and mediolateral visualization, facilitating complete and safe excision of the lesion. Postoperative MRI and CT confirmed a gross-total resection. Objective outcome was GCS 15/15, mRS 1/6, no cranial nerve deficits, and improved strength (5/5 left; 4/5 right). Discharge occurred on postoperative day 14. In carefully selected dorsolateral pontine cavernous malformations, a minimal QLC resection can expand operative freedom while respecting functional boundaries and vascular preservation principles with favorable postoperative functional outcomes.