Ahead of Print: Contralateral Interhemispheric Approach to Deep-Seated Cavernous Malformations

Screen Shot 2014-05-20 at 9.43.30 AMBackground: 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 inter-hemispheric approach.

Methods: Retrospective chart review was performed on patients undergoing an interhemispheric approach for resection of deep-seated cavernous malformation by the senior author (RFS) between 2005-2013. 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 with a contralateral interhemispheric-transcingulate approach, and 3 patients with a contralateral interhemispheric-transchoroidal approach. Mean age was 40.1 yrs, 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 9.2 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. 6.5% of patients experienced transient weakness which resolved at last follow-up, and one 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.

From: Contralateral Interhemispheric Approach to Deep-Seated Cavernous Malformations: Surgical Considerations and Clinical Outcomes in 31 Consecutive Cases by Zaidi et al.

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