Resection of an anterolateral mesencephalic cavernoma via transsylvian/transuncal approach in a child

Abstract

This video demonstrates the resection of an anterolateral mesencephalic cavernous malformation (CM) through a trans-sylvian/transuncal approach. A 10-year-old girl presented with progressive headache and left-sided spastic hemiparesis. Neuroimaging revealed a 20-mm CM located in the right anterolateral midbrain/cerebral peduncle. After orbitozygomatic craniotomy and wide sylvian fissure opening, the oculomotor nerve was dissected and separated from the temporal lobe. Partial resection of the uncus allowed access to the CM through the oculomotor-tentorial triangle. The CM was excised in a piecemeal fashion. Postoperative imaging confirmed the gross-total resection. The patient had no additional neurological deficits postoperatively. Her left hemiparesis almost completely resolved at the 12-month follow-up. The video can be found here: https://youtu.be/Jb_EaWbn5LU.