Endoscopic Paramedian Sitting Craniotomy for Resection of a Dorsal Midbrain Cavernous Malformation: 2-Dimensional Operative Video

This case video demonstrates the surgical technique for resection of a cavernous malformation in the right dorsal midbrain. This video was deemed exempt by the University of Pennsylvania Institutional Review Board (IRB), as it is considered a case report, which does not require IRB approval or patient consent. The patient was a 57-yr-old male with cerebral cavernous malformation syndrome with multiple intracranial cavernomas. He was noticed to have progressively slowed speech with worsening confusion and drowsiness. On exam, the patient exhibited worsening in swallowing and upward gaze paresis, secondary to Parinaud phenomena. The patient was treated with microsurgical resection, utilizing stereotactic navigation and intraoperative neurophysiologic monitoring. Intraoperative view provided in the video was captured using a Karl Storz Endoscope (Karl Storz SE & Co KG, Tuttlingen, Germany). Postoperatively, the patient had worsening double vision, which improved on follow-up, in addition to improvement in sensorium and swallowing.