• Luis Gustavo Biondi-Soares, Érico Samuel Gomes Galvão da Trindade, Rene Alejandro Apaza-Tintaya, Luis Ángel Canache Jiménez, Felipe Salvagni Pereira, Pedro Henrique Teixeira Soto Iscal, Alexander Feliciano Vilcahuamán Paitán, Edgar David Tenelema Aguaisa, and Feres Chaddad-Neto.
• Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
• World Neurosurg. 2024 May 1; 185: 727372-73.

AbstractCavernous malformations (CMs) account for 10%-15% of all vascular malformations and represent the second most common type of cerebral vascular lesion.1 They typically occur in the cerebral subcortex or white matter.2 CMs located in the thalamus are rare.3 When we isolate the group of thalamic CMs, we find a bleeding risk of >5% per year, with a rebleeding rate exceeding 60%, often occurring within 1 year of the initial bleeding.1 The deep location and proximity to eloquent brain regions make thalamic CMs challenging for neurosurgeons.4,5 Surgeons can access the posterolateral thalamus through various surgical approaches, such as transcallosal transventricular, supracerebellar transtentorial, intraparietal sulcus, and transcortical methods. Selecting the best surgical approach requires considerable expertise, considering the patient's preoperative condition and the lesion's location.6-12 We discuss a complex case involving a 24-year-old patient with a right thalamic cavernoma and a history of 3 prior bleeding events. We present a step-by-step transcortical approach through the posterior portion of the superior temporal gyrus (Video 1). The patient consented to the procedure and publication of images. We demonstrate how the transtemporal posterior trajectory provides an optimal working corridor for safely removing this cavernous malformation without introducing new deficits.Copyright © 2024 Elsevier Inc. All rights reserved.

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