{"id":"461ff90c-d780-4113-abb9-4b20d53a2a3d","slug":"microsurgical-resection-of-quadrigeminal-cavernoma-and-preservation-of-developmental-venous-anomaly-through-a-subtemporal-approach","title":"Microsurgical resection of quadrigeminal cavernoma and preservation of developmental venous anomaly through a subtemporal approach","authors":["Siddharth Srinivasan","Vishnu Suresh","Mithun Sattur","Patrick Opperman","Caroline Farrell","Nicholas Borg"],"abstract":"Background: Quadrigeminal cavernomas are rare midbrain cavernous malformations with potential for recurrent hemorrhage, aqueductal compression, hydrocephalus, brainstem dysfunction, and death. Surgical management is complicated when a developmental venous anomaly (DVA) is associated with the lesion, as injury to this venous drainage can result in brainstem infarction. Therefore, treatment must balance definitive lesion control with meticulous preservation of the DVA. Case Description: A 26-year-old man presented with an episode of acute headache and was found on magnetic resonance imaging to have a right dorsolateral quadrigeminal cavernoma (9.4 × 9.5 mm), with associated hemorrhage, triventricular hydrocephalus, and a DVA draining into the vein of Galen complex. Endoscopic third ventriculostomy was initially performed to temporize hydrocephalus, and he was discharged without deficit. Five months later, he re-presented with recurrent headache. Repeat imaging demonstrated interval lesion enlargement, rehemorrhage, and recurrent hydrocephalus. An external ventricular drain was placed. Given the patient’s young age, recurrent hemorrhage, lesion growth, and ongoing obstructive hydrocephalus, definitive microsurgical resection under neuromonitoring was recommended. A subtemporal approach through the supratrochlear corridor using the lateral mesencephalic safe entry zone was selected to optimize access while preserving the vein of Labbe. Gross-total resection was achieved without neurological deficit, with preservation of the DVA and restoration of aqueductal patency. Conlcusion: Quadrigeminal cavernomas with associated DVA require individualized operative planning because the DVA commonly drains into the deep venous system or the vein of Galen complex. In selected patients, the subtemporal supratrochlear route provides effective access for safe resection and minimizes neurological morbidity. 0:09 Clinical presentation. 0:28 Endoscopic third ventriculostomy. 0:58 Recurrent symptoms and repeat imaging. 1:34 Rationale for the procedure. 2:06 Risks and potential benefits of surgery. 3:00 Alternatives and why they were not chosen. 3:37 Surgical approach planning. 4:02 Description of Setup. 4:26 Skin incision and subtemporal approach. 4:47 Ambient cistern dissection and trochlear nerve mobilization. 5:33 Lateral mesencephalic safe entry zone and cavernoma dissection. 6:37 Disconnection of cavernoma from developmental venous anomaly. 7:05 Hemostasis and closure. 7:33 Disease background and discussion. 8:11 Postoperative course. Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. 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. https://doi.org/10.25259/SNI_445_2026 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":"2026-05-29T00:00:00.000Z","doi":"10.25259/SNI_445_2026","categories":["Neurovascular","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/461ff90c-d780-4113-abb9-4b20d53a2a3d/pdf"}