A Case of Cavernous Malformation of the Midbrain Removed via an Interhemispheric Transcallosal Subchoroidal Approach

Abstract

Cavernous malformations of the midbrain have a higher rate of hemorrhage and a poorer prognosis than vascular malformations of other brain areas. Surgical resection of these lesions is often necessary to avoid neurological deficits in affected patients. Herein, the literature surrounding cavernous malformations was examined, and the case of a 48-year-old man with left hemiparesis and diplopia caused by incomplete right oculomotor nerve palsy, who was diagnosed with a hemorrhage from a midbrain cavernous malformation, was discussed. The lesion expanded gradually on magnetic resonance imaging and was symptomatic; radical removal of the lesion before the onset of irreversible symptoms due to recurring bleeding was therefore considered to be beneficial for the patient. Surgical removal of the entire cavernous malformations of the midbrain was performed using an interhemispheric transcallosal subchoroidal approach, with excellent postoperative results and complete recovery from the oculomotor nerve palsy and left hemiparesis. This case shows that this approach is the most appropriate for surgical resections of lesions in the upper midbrain.

Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities

“…4 MEP altered signals can result due to surgical insult, hypotension, anesthetic agents, hypothermia, technical glitch, and brain shift. 5,6 Surgeries in semisitting position can alter the MEP and SSEP signals indirectly by drastically reducing the cardiac output during VAE. It is uncertain whether VAE impacts SSEPs and MEPs.…”