Keywords
thalamic cavernoma - contralateral - supracerebellar infratentorial approach - neurovascular
anatomy - skull base
Fig. 1 Tentorial venous sinuses of the posterior fossa.
Fig. 2 Surgical corridor through contralateral approach to the left Pulvinar.
Fig. 3 Topographic cerebellar surgical anatomy.
Fig. 4 Posterior incisural space and relevant great caliber venous elements encountered.
Objective: This study aims to assess the feasibility and effectiveness of utilizing the contralateral
supracerebellar-infratentorial (cSCIT) approach in the surgical resection of thalamic
cavernous malformations (CMs). Given their deep-seated location and close proximity
to vital neurovascular structures, thalamic CMs present considerable challenges for
surgical intervention. The cSCIT approach, a novel iteration of the established SCIT
technique, offers a distinctive vantage point for addressing CMs situated posteriorly
within the thalamus.
Method: This study entailed a detailed analysis of a single patient who underwent thalamic
CM resection through the cSCIT approach, specifically chosen for its complexity; in
addition a literature review on the subject was conducted. Employing a torcular craniotomy
with the patient in a seated position facilitated gravity-assisted cerebellar retraction.
The surgical procedure involved systematic disentanglement of arachnoid adhesions
and preservation of crucial veins and arteries to mitigate the potential for complications.
Results: In the midst of complex brain surgery, particularly when facing the technical challenges
of resecting cerebral lesions located deep within the brain or skull base, surgeons
encounter the need to discover effective pathways to access these elusive lesions.
Thalamic CMs are often situated in the depths of the abyss, presenting a formidable
task due to their narrow and profound location, surrounded by critical neurovascular
structures. Moreover, these lesions can be found within or adjacent to essential cortical
matter, further complicating the surgical approach. The outcomes have demonstrated
successful resection of thalamic CMs, resulting in complete lesion removal and minimal
postoperative neurological deficits. The cSCIT approach enabled a direct and unobstructed
view of the posterior thalamus, circumventing the visual limitations imposed by the
occipital lobe and tentorium as observed in conventional ipsilateral approaches.
Conclusion: The findings of this research underscore the capacity of the cSCIT approach to augment
the scope of the SCIT technique, affording enhanced visualization and resection capabilities
for thalamic CMs positioned laterally to the midline. This approach has proven to
be a secure and efficacious surgical alternative for thalamic CMs cases.
