Contralateral Transcingulate Resection of Midcingulate Cavernous Malformation

This case video demonstrates the surgical technique for resection of a cavernous malformation in the midleft cingulate gyrus using a contralateral transcingulate approach (Video 1). The indications for operating on a cavernoma such as this are seizures, recurrent hemorrhages, and a surgically resectable target. This video describes the operative steps, positioning, incision, and craniotomy for this approach. In addition, risks of air embolism, interhemispheric exposure, use of stereotactic navigation, and benefits of gravity retraction are highlighted. The contralateral transcingulate approach is indicated as it reduces the need for retraction by employing gravity retraction. Further, this approach is advantageous as it prevents injury to the left sided eloquent cortex, affords comfortable surgeon position and offers an improved trajectory. This case illustrates a well-described albeit unique surgical technique for cavernous malformation repair in an operative video format. In addition, this case shows that this technique results in a favorable patient outcome with minimal complication when appropriately used.