Resection of anterolateral midbrain cavernous malformation via orbitozygomatic transsylvian pretemporal approach with...

Brainstem cavernomas are benign, angiographically occult, low-flow lesions and constitute 18%-35% of intracranial cavernomas.^4,6 They are known to have an annual rupture risk of 2%-6%,^2,5 and once symptomatic, they frequently cause progressive neurological morbidity. A 22-year-old lady presented with progressive profound neurologic deficits from three distinct hemorrhages over 2 months. Surgery was indicated given the aggressive natural history, and the lesion now presented to the surface with displacement of corticospinal tracts noted on diffusion tensor imaging.^1,7 We describe a surgical technique via an orbitozygomatic transsylvian pretemporal approach with uncal resection to open the oculomotor-tentorial window and resect the lesion.³ The video can be found here: https://youtu.be/j5yYp4OsaRc.