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Third Ventricular Cavernous Malformations: Approach Selection for Minimally Invasive Resection and Systematic Review.
Benjamin Fixman1, Danielle Levy, Ishan Shah
1Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles , California , USA.
Operative Neurosurgery (Hagerstown, Md.)
|February 17, 2026
Summary
Minimally invasive techniques like supraorbital translamina terminalis and port-based transcortical approaches offer safe and effective resection of third ventricular cavernous malformations (TVCMs). These methods complement traditional surgeries, achieving good outcomes for deep-seated brain lesions.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Minimally Invasive Procedures
Background:
- Cavernous malformations (CMs) are benign central nervous system vascular lesions.
- Ventricular involvement is rare (<10%), with third ventricle CMs posing surgical access challenges.
- Symptomatic third ventricular cavernous malformations (TVCMs) require effective and safe resection strategies.
Purpose of the Study:
- To describe the institutional experience with 3 patients treated for symptomatic TVCMs.
- To review literature on minimally invasive surgical approaches for TVCM resection.
- To evaluate the feasibility and outcomes of adapted minimally invasive neurosurgical techniques for TVCMs.
Main Methods:
- Case series of 3 patients with TVCMs, including demographic, symptomatic, and surgical outcome data.
- Systematic literature review following PRISMA guidelines using PubMed and Embase databases.
- Analysis of minimally invasive approaches: supraorbital keyhole endoscopic-assisted resection (translamina terminalis) and port-based transcortical exoscopic-assisted resection.
Main Results:
- All 3 institutional patients achieved gross total resection without complications or permanent memory deficits.
- Systematic review of 51 additional patients showed gross total resection in 86.8% via various approaches.
- Minimally invasive techniques demonstrated feasibility and safety, complementing traditional methods for TVCM treatment.
Conclusions:
- Minimally invasive neurosurgical techniques, including supraorbital translamina terminalis and port-based transcortical approaches, are feasible for TVCM resection.
- These adapted techniques offer reasonable safety and surgical outcomes, comparable to traditional open cranial approaches.
- Successful resection of deep-seated TVCMs can be achieved with careful selection and application of minimally invasive strategies.
