{"id":"a4c08a56-681c-4727-9d73-0317eaf73549","slug":"cavernoma-of-the-left-ventral-striatum-anatomical-and-microsurgical-implications-of-the-ipsilateral-transcallosal-transrostral-pathway","title":"Cavernoma of the left ventral striatum, anatomical and microsurgical implications of the ipsilateral transcallosal transrostral pathway","authors":["Alejandro Benjamin Romero Leguina","Luis Ángel Canache Jiménez","Mariano Teyssandier","Álvaro Rodrigo Quiñones Céspedes","Sebastian Juan Mária Giovannini","Mariela Cecilia Salerno","Erica Antunes Effgen","Érico Samuel Gomes Galvão da Trindade","José Maria de Campos Filho","Feres Chaddad-Neto"],"abstract":"Background: Cerebral cavernous malformations are vascular abnormalities of the central nervous system with an incidence of 0.4–0.5% and an annual hemorrhage rate ranging from 0.7% to 1%. The most important and consistent risk factor for rebleeding is a prior hemorrhage, and deep lesions (within the thalamus, basal ganglia, and brainstem) characteristically carry a worse prognosis regarding annual hemorrhage rates (10.6% per patient per year vs 0.4% per patient per year for superficial cerebral lesions) and subsequent neurologic deterioration. The ventral striatum is a difficult region to approach. The conservative treatment and also radiosurgery are not compatible with this kind of lesion, in the virtue of the eloquence and high risk of rebleeding, and the worsening of the perilesional edema, respectively, resulting in a motor deficit. Case Description: This video presents a case of a 37-year-old male patient with a 6-month history of headaches, with a magnetic resonance imaging (MRI) showing a lesion in the left ventral striatum compatible with cavernoma with signs of recent bleeding. The patient underwent an ipsilateral transcallosal transrostral approach. The procedure was uneventful, and the patient was discharged without neurological deficits. A postoperative MRI confirmed complete resection. Conclusion: The anatomical aspects to consider are analyzed as the dissection progresses toward the lesion, and the other surgical alternatives are studied in this video. The ipsilateral transcallosal transrostral pathway permits an intuitive awareness of the midline at all times, facilitating safer manipulation of the brain tissue when accessing deep-seated lesions. Consequently, the risk of intraoperative and postoperative complications decreases. 00:13 – Clinical presentation and imaging findings. 1:08 – Rationale and alternatives. 3:16 – Necessary equipment. 3:33 – Key surgical steps. 3:56 – Anatomical review. 4:48 – Pathway through the interhemispheric fissure. 6:03 – Opening of the body of corpus callosum to the frontal horn of the left lateral ventricle. 6:25 – Opening of the rostrum of the corpus callosum. 7:02 – Hematoma evacuation and 360° dissection of the cavernoma. 8:58 – Disease background. 9:23 – Imaging and clinical outcome. Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/neurovascular.png","publishDate":"2025-05-23T00:00:00.000Z","doi":"10.25259/SNI_285_2025","categories":["Neurovascular","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2025/05/13567/SNI-16-199.pdf"}