Surgical treatment of ventral mesencephalic cavernoma

The treatment of an intrinsic midbrain tumour has always been controversial due to the precarious nature of its location. We report a rare example of a cavernoma located in the ventral mesencephalon and presented clinically as Holmes' tremor. In order to access this vital portion of midbrain, we chose a fronto-temporal trans-sylvian route via an orbito-zygomatic craniotomy. The cavernoma was removed en bloc with a longitudinal pial incision between the fronto-pontine fibers and the pyramidal tracts in the peduncle. After the operation, the tremor dramatically disappeared. Through a review and analysis of the literature, we discuss the surgical strategy for management of an anterior midbrain cavernoma. With an optimal surgical approach, fairly safe entry zones on the anterior face of the rostral brainstem may be accessible, which makes it possible for successful resection of a ventral mesencephalic cavernoma without postoperative complications.