Modified Transanterior Perforated Substance Approach Using the Medial Territory to Thalamomesencephalic Cavernous Malformations: A Case Report

Abstract

BACKGROUND AND IMPORTANCE: Thalamomesencephalic lesions remain a challenge to neurosurgeons for their eloquent anatomy and postoperative neurological deficits. With limited cases in the literature, these lesions are still managed in a case-by-case fashion. CLINICAL PRESENTATION: Here, we present a case of an otherwise healthy man who had a 46-day history of impaired vision and right-sided weakness and numbness caused by ventrally located thalamomesencephalic cavernous malformations (CMs). A modified transanterior perforated substance approach using the medial territory was performed for gross total resection of the CMs. No new-onset neurological deficits were observed postoperatively. Apart from visual improvements, the patient's muscle strength constantly improved and recovered full strength on 14-month follow-up. CONCLUSION: The authors believe that the transanterior perforated substance approach through the medial territory can be considered as an option for ventrally located thalamomesencephalic CMs.