Abstract
Approaches to the pineal region are various, and each has its advantages and disadvantages. The authors present a case of a 50-year-old woman who presented with progressive hemiparesis and vertical gaze palsy; she was diagnosed with a midbrain cavernous malformation. The patient underwent an occipital posterior interhemispheric supratentorial transpineal approach with gross-total resection. On long-term follow-up, her symptoms significantly improved. The authors review the regional anatomy and present the operative video. They also discuss the various approaches with their indications, advantages, and disadvantages.The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2133.
Highlights
This is a 50-year-old female diagnosed with a midbrain cavernous malformation who underwent radiosurgery at an outside institution
This T2 sequence MRI shows a classic appearance of cavernous malformation with a hemosiderin ring visualized
The rationale for the procedure is for the progressive neurological deficits and prevention of mass effect and hemorrhage
Summary
This is a 50-year-old female diagnosed with a midbrain cavernous malformation who underwent radiosurgery at an outside institution. Her neurological examination included a complete vertical gaze palsy, 4/5 power in her right upper and lower extremity, as well as hyperreflexia on the right. This T2 sequence MRI shows a classic appearance of cavernous malformation with a hemosiderin ring visualized. Is a T1 coronal and sagittal image showing the cavernous malformation.
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