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Modified Transanterior Perforated Substance Approach Using the Medial Territory to Thalamomesencephalic Cavernous
Yunjia Ni1, Zhiyu Wang2, Zhongshuai Zhang3
1Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background And Importance:
Thalamomesencephalic lesions remain a challenge to neurosurgeons for their eloquent anatomy and postoperative neurological deficits. With limited cases in the literature, these lesions are still managed in a case-by-case fashion.
Clinical Presentation:
Here, we present a case of an otherwise healthy man who had a 46-day history of impaired vision and right-sided weakness and numbness caused by ventrally located thalamomesencephalic cavernous malformations (CMs). A modified transanterior perforated substance approach using the medial territory was performed for gross total resection of the CMs. No new-onset neurological deficits were observed postoperatively. Apart from visual improvements, the patient's muscle strength constantly improved and recovered full strength on 14-month follow-up.
Conclusion:
The authors believe that the transanterior perforated substance approach through the medial territory can be considered as an option for ventrally located thalamomesencephalic CMs.
