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- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros, São Paulo, Brazil
- Department of Neurosurgery, Hospital de Niños Sor Maria Ludovica, La Plata, Buenos Aires, Argentina
Correspondence Address:
Feres Chaddad-Neto, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros, São Paulo, Brazil.
DOI:10.25259/SNI_285_2025
Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Alejandro Benjamin Romero Leguina1, Luis Ángel Canache Jiménez1, Mariano Teyssandier1, Álvaro Rodrigo Quiñones Céspedes1, Sebastian Juan Mária Giovannini1, Mariela Cecilia Salerno2, Erica Antunes Effgen1, Érico Samuel Gomes Galvão da Trindade1, José Maria de Campos Filho1, Feres Chaddad-Neto1. Cavernoma of the left ventral striatum, anatomical and microsurgical implications of the ipsilateral transcallosal transrostral pathway. 23-May-2025;16:199
How to cite this URL: Alejandro Benjamin Romero Leguina1, Luis Ángel Canache Jiménez1, Mariano Teyssandier1, Álvaro Rodrigo Quiñones Céspedes1, Sebastian Juan Mária Giovannini1, Mariela Cecilia Salerno2, Erica Antunes Effgen1, Érico Samuel Gomes Galvão da Trindade1, José Maria de Campos Filho1, Feres Chaddad-Neto1. Cavernoma of the left ventral striatum, anatomical and microsurgical implications of the ipsilateral transcallosal transrostral pathway. 23-May-2025;16:199. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13567
Date of Submission
21-Mar-2025
Date of Acceptance
23-Apr-2025
Date of Web Publication
23-May-2025
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.
Keywords: Anatomical aspects, Cavernous malformation, Interhemispheric, Ipsilateral, Vascular neurosurgery, Ventral striatum
Video 1
Timed Annotations[1,7]
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.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
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.
Disclaimer
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.
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