Resection of anterolateral midbrain cavernous malformation via orbitozygomatic transsylvian pretemporal approach with uncal resection.

Brainstem cavernomas are benign, angiographically occult, low-flow lesions and constitute 18%-35% of intracranial cavernomas. They are known to have an annual rupture risk of 2%-6%, and once symptomatic, they frequently cause progressive neurological morbidity. A 22-year-old lady presented with progressive profound neurologic deficits from three distinct hemorrhages over 2 months. Surgery was indicated given the aggressive natural history, and the lesion now presented to the surface with displacement of corticospinal tracts noted on diffusion tensor imaging. We describe a surgical technique via an orbitozygomatic transsylvian pretemporal approach with uncal resection to open the oculomotor-tentorial window and resect the lesion. The video can be found here: https://youtu.be/j5yYp4OsaRc.