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Updated: Mar 19, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Contralateral Transcingulate Approach for Periventricular Cavernous Malformations Presenting With Intraventricular
Amanrai S Kahlon1, Najib Muhammad, Christopher Sollenberger
1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background And Objectives:
The contralateral transcingulate-transcallosal approach offers access to lesions seated in the deep medial frontal and parietal lobes with direct visualization of reliable anatomic landmarks. We describe the operative anatomy and technique for resecting pericallosal or periventricular cavernous malformations presenting with intraventricular hemorrhage or subarachnoid hemorrhage.
Methods:
Three cases of pericallosal or periventricular cavernous malformations with intraventricular hemorrhage or subarachnoid hemorrhage were treated using a contralateral transcingulate approach. Operative nuances related to patient positioning, anatomic corridors, and manipulation of the pericallosal and callosomarginal arteries were emphasized.
Results:
Complete resection was achieved in all 3 cases without intraoperative or postoperative complications. In each case, anatomic variations dictated adjustments to the surgical corridor to maximize safe exposure and minimize retraction.
Conclusion:
The contralateral transcingulate approach provides a steeper angle of exposure for the resection of lesions in the wall of, or protruding into, the ventricle. This approach may offer unique benefits in select cases, when carefully planned with consideration of key anatomic landmarks, over the transcallosal or transcortical approaches when indicated after careful anatomic consideration of the lesion.
