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    Microsurgical resection of a midbrain cavernous malformation via the paramedian supracerebellar infratentorial trans-lateral mesencephalic sulcus approach using the dynamic lateral semi-sitting position: 2-dimensional operative video with 3D anatomical models
    (2025) Bulgur, Feride; Fidan, Semih; Bağcı, Seyhun; Gökalp, Elif; Luzzi, Sabino; Güngör, Abuzer
    Brainstem cavernous malformations are relatively rare lesions with a higher tendency of hemorrhage than supratentorial cavernous malformations. Due to the compact arrangement of fiber tracts and nuclei of the region, any hemorrhagic event can cause severe neurological deficits. This eloquent architecture of the area also makes any surgical attempt challenging. Anatomical location and dimension of the lesion, presence of hemorrhage, age, and the neurological status of the patient need to be considered before determining the appropriate course of treatment. A surgical approach is preferred for young symptomatic patients with at least 1 previous episode of bleeding. Subtemporal and supracerebellar infratentorial approaches can be used to access these lesions.1-5 We present a 44-year-old woman with a hemorrhagic tegmental cavernous malformation presenting with imbalance and right-sided hemiparesis (Video 1). The paramedian supracerebellar infratentorial translateral mesencephalic sulcus approach is used to resect the lesion with the patient in a dynamic lateral semisitting position. The paramedian variant of the supracerebellar infratentorial approach provides a relatively bridging vein-free corridor compared with midline approaches.6 With the patient in the semisitting position, gravity retraction of the brain provided a natural corridor with a clear surgical field. In the dynamic lateral semisitting position, we aimed to reduce the risk of venous air embolism associated with the sitting position by keeping the patient in the lateral decubitus position during the dural and extradural phases of the surgery.
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    Tailored Callosotomy in Third Ventricle Colloid Cyst Resection via Anterior Interhemispheric Transcallosal Approach
    (2025) Özöner, Barış; Gürses, Muhammet Enes; Öztürk, Mehmet; Arslan, Safa; Ergen, Anıl; Tubbs, Richard S.; Gonzalez-Lopez, M. Pablo; Luzzi, Sabino; Güngör, Abuzer
    Background: The colloid cyst represents a relatively uncommon intracranial lesion. It garners significant attention from neurosurgeons due to its benign nature, deep-seated location, and promising prognosis when identified early and surgically removed. A variety of surgical methods are used to treat these cysts, each with their strengths and weaknesses. Objectives: The aim of this study to introduce and assess a precise microsurgical technique for managing colloid cysts using the anterior interhemispheric transcallosal approach. Methods: The research involved a retrospective analysis of 14 cases between 2021 and 2023 treated with the anterior interhemispheric transcallosal approach by two experienced skull base surgeons. The evaluation encompassed demographic, clinical, radiological, histological, and surgical data. Additionally, the Colloid Cyst Risk Score (CCRS) was used to assess the risk of obstructive hydrocephalus. The procedure incorporated neuronavigation and ultrasound to determine the precise entry point and to plan the trajectory. Results: The minimally invasive microsurgical technique was effectively employed in all 14 cases, with no reported postoperative complications. Post-surgery MRI scans confirmed complete cyst removal, with an average callosotomy measurement of 5.4 ± 2.5 mm. Importantly, none of the patients experienced disconnection syndrome associated with callosotomy. Conclusions: The adapted microsurgical approach via the anterior interhemispheric transcallosal method emerges as a secure and efficient way to address colloid cysts. It ensures comprehensive cyst removal while minimizing complications, boasting advantages such as reduced invasiveness, enhanced visibility, and minimal tissue disturbance, thereby confirming its role in colloid cyst surgical interventions.