Transcallosal Anterior Interforniceal Approach for Removal of Superior Midbrain Cavernous Malformations in Children: A Retrospective Series of 10 Cases in a Single Center

Abstract

Surgical treatment of brainstem cavernous malformations (CMs) remains a great challenge for neurosurgeons. Several cases published in the literature have addressed surgical approaches. However, no surgical approach has been reported to provide better exposure for CMs located in the superior midbrain. We presented 10 cases of superior midbrain CMs in children treated in Beijing Tiantan Hospital from 2002 to 2016. The most common presenting signs and symptoms were hydrocephalus and cranial nerve deficit. We used the transcallosal anterior interforniceal approach in all patients to remove the CM lesion. Total resection was achieved in all patients. During the follow-up period, temporary short-term memory impairment was present in 5 patients, unilateral ptosis occurred in 1 patient, and upward gaze dysfunction occurred in 2 patients. There was complete neurologic functional improvement for cranial nerves. Exacerbation of hydrocephalus occurred in 4 patients requiring additional ventriculoperitoneal shunt postoperatively. The transcallosal anterior interforniceal approach can provide good exposure and direct visualization to superior midbrain CMs. Complications are short-term and reversible.