Contralateral interhemispheric approach to deep-seated cavernous malformations: surgical considerations and clinical outcomes in 31 consecutive cases.

BACKGROUND Deep-seated periventricular cavernous malformations of the basal ganglia or thalamus can be approached via an interhemispheric craniotomy. OBJECTIVE To determine surgical efficacy and clinical outcomes of the contralateral interhemispheric approach. METHODS Retrospective chart review was performed on patients undergoing an interhemispheric approach for the resection of deep-seated cavernous malformation by the senior author (R.F.S.) between 2005 and 2013. Demographic data and clinical outcomes were reviewed. Pre- and postoperative imaging were analyzed for lesion location, size, associated venous anomaly, proximity to ventricle, and presence of residual. RESULTS Twenty-one patients underwent a contralateral interhemispheric-transventricular approach, 7 patients had a contralateral interhemispheric-transcingulate approach and 3 patients had a contralateral interhemispheric-transchoroidal approach. Mean age was 40.1 years, and the majority were female (58.1%). Mean maximum cavernoma diameter was 1.97 cm, and 43.8% reached the surface of the ventricle. Average follow-up was 8.9 months, with complete resection achieved in 96.8% of patients. At last follow-up, 61.3% of patients remained stable and 29.0% had improved. Of the patients, 6.5% experienced transient weakness that resolved at last follow-up, and 1 patient (3.2%) had short-term memory problems. There were no surgical mortalities. CONCLUSION The contralateral interhemispheric approach is a safe, clinically well tolerated, and surgically efficacious approach to deep-seated cavernomas.

[1]  R. Spetzler,et al.  Trans-striatocapsular contralateral interhemispheric resection of anterior inferior basal ganglia cavernous malformation. , 2013, World Neurosurgery.

[2]  Wei Zhu,et al.  A solution to meningiomas at the trigone of the lateral ventricle using a contralateral transfalcine approach. , 2013, World neurosurgery.

[3]  M. Lawton,et al.  Contralateral transcallosal approach to basal ganglia cavernous malformation: 3-dimensional operative video. , 2013, Neurosurgery.

[4]  M. Lawton,et al.  The Contralateral Transcingulate Approach: Operative Technique and Results With Vascular Lesions , 2012, Neurosurgery.

[5]  R. Spetzler,et al.  The quiet revolution: retractorless surgery for complex vascular and skull base lesions. , 2012, Journal of neurosurgery.

[6]  R. Spetzler,et al.  Advances in the Treatment and Outcome of Brainstem Cavernous Malformation Surgery: A Single-Center Case Series of 300 Surgically Treated Patients , 2011, Neurosurgery.

[7]  R. Spetzler,et al.  Surgical approaches to brainstem cavernous malformations. , 2010, Neurosurgical focus.

[8]  U. Sure,et al.  The benefit of image guidance for the contralateral interhemispheric approach to the lateral ventricle , 2008, Clinical Neurology and Neurosurgery.

[9]  G. Oliveri,et al.  The transcallosal approach for lesions affecting the lateral and third ventricles , 1991, Acta Neurochirurgica.

[10]  A. Goel.  Transfalcine approach to a contralateral hemispheric tumour , 2005, Acta Neurochirurgica.

[11]  S. Gorelyshev,et al.  Surgical treatment of anterior third ventricle tumours , 2005, Acta Neurochirurgica.

[12]  J. Golfinos,et al.  The contralateral transcallosal approach: experience with 32 patients. , 1996, Neurosurgery.

[13]  Ap Brown.  The two-point method : Evaluating brain stem lesions , 1996 .

[14]  M. Hadley,et al.  Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity. , 1991, Neurosurgery.

[15]  B. Drayer,et al.  Appearance of venous malformations on magnetic resonance imaging. , 1988, Journal of neurosurgery.

[16]  M. Hadley,et al.  Cerebral cavernous malformations. Incidence and familial occurrence. , 1988, The New England journal of medicine.

[17]  T. Kojima,et al.  Arteriovenous malformations of the lateral ventricle. , 1985, Journal of neurosurgery.

[18]  A. Rhoton,et al.  Microsurgery of the third ventricle: Part 2. Operative approaches. , 1981, Neurosurgery.

[19]  B. Stein.  Third ventricular tumors. , 1980, Clinical neurosurgery.

[20]  K. Winston,et al.  Absence of Neurological and behavioral abnormalities after anterior transcallosal operation for third ventricular lesions. , 1979, Neurosurgery.

[21]  B. Stein,et al.  Transcallosal approach to the anterior ventricular system. , 1978, Neurosurgery.