Contralateral Interhemispheric Transfalcine Approach to the Basal Ganglia

The contralateral interhemispheric approach provides a robust path into the mesial frontal lobe and basal ganglia structures.¹ The use of gravity to retract the dominant frontal lobe allows the surgeon to avoid injury caused by exposure of the dominant hemisphere. The transfalcine corridor, however, is long and often not well illuminated, necessitating the use of lighted instruments. Within the path of approach lie the anterior cerebral arteries, which must be carefully dissected and preserved. Upon opening the falx, the entire mesial frontal lobe and deep basal ganglia structures can be readily accessed. Herein, we present a patient with familial cerebral cavernous malformation-1 syndrome who presented after an acute hemorrhage from a deep basal ganglia cerebral cavernous malformation (Video 1). The patient consented to the procedure. The patient was hemiparetic and aphasic, likely secondary to mass effect from the bleed. The lesion was approached from a contralateral interhemispheric approach and removed completely. The patient's examination improved with removal of the mass lesion. This case demonstrates the utility of this approach for accessing deep corridors within the cerebral cortices.