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Access to the ventrolateral pontomesencephalic area may be required for resecting cavernous malformations, performing revascularization of the upper posterior circulation, and treating vascular lesions such as aneurysms. However, such access is challenging because of nearby eloquent structures. Commonly used corridors to this surgical area include the optico-carotid, supracarotid, and carotid-oculomotor triangles. However, the window lateral to the oculomotor nerve can also be used and has not been studied. The authors describe the anatomical window formed between the oculomotor nerve and the medial tentorial edge (the oculomotor-tentorial triangle [OTT]) to the ventrolateral pontomesencephalic area, and assess techniques to expand it.

Four cadaveric heads (8 sides) underwent orbitozygomatic craniotomy. The OTT was exposed via a …