Microsurgical resection for cavernous malformation of the Uncus: 3D-operative video.

Cavernous malformations (CMs) are rare and often oligosymptomatic vascular lesions. The main symptoms include seizure and focal neurological deficits.1-3 Depending on the symptomatology, the location, the size, and the risk factors for bleeding, like the presence of a developmental venous anomaly, it can be highly morbid. Thus, surgical resection may be considered. Deep-seated and eloquent CMs, like those in the uncus, can be challenging.4,5 In this operative video, we present a 23-year-old male adult who developed focal seizures (i.e., oral automatisms) after an episode of sudden intense headache one year ago. His neurological examination was unremarkable. The patient consented to the procedure and to the publication of his/her image. Nevertheless, his magnetic resonance images showed an uncal 2cm Zabramski type I CM. We exposed the insula and its limen through a right pterional craniotomy and transsylvian corridor. During the video, we discuss the surgical nuances to access and resect this CM lesion en bloc while preserving important vascular structures and white matter tracts. Postoperative neuroimaging demonstrated total resection. In postoperative day 1, the patient had one episode of generalized seizure and evolved with contralateral hemiparesis. The patient had a good recovery and was discharged on postoperative day 21. At the 6-month follow-up, the patient had no new epileptic events and presented complete weakness improvement. Through this minimally invasive and well-known surgical corridor, we preserve the mesial and lateral portion of the temporal lobe, reducing the risk of lesions to Meyer's loop and the limbic association area.