Third Ventricular Cavernous Malformations: Approach Selection for Minimally Invasive Resection and Systematic Review.
Benjamin Fixman, Danielle Levy, Ishan Shah et al.
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Case in brief
Three patients with symptomatic third-ventricular cavernous malformations had signs of intracapsular hemorrhage but no hydrocephalus. Two underwent supraorbital keyhole, endoscopic-assisted resection through the translamina terminalis; the third had port-based, trans-sulcal exoscopic-assisted resection through a right frontal keyhole craniotomy. Gross total resection was achieved in all three, without complications or permanent memory deficits. The accompanying systematic review identified 51 additional patients; across the reviewed cases, gross total resection was achieved in 46 of 53, while reported postoperative morbidity included permanent memory loss, hydrocephalus, and death.
What made this case unusual
The three institutional cases illustrate two selectively adapted minimally invasive routes to the third ventricle: supraorbital translamina terminalis and port-based transcortical resection, rather than relying solely on traditional open approaches.
Diagnostic / clinical pearl
Third-ventricular cavernous malformations may present with signs of intracapsular hemorrhage even without hydrocephalus; surgical access can be tailored to the lesion using minimally invasive approaches.