Insular cavernous malformation resection through a minipterional, transsylvian approach

Peyton L Nisson; Robert T Wicks; Xiaochun Zhao; Whitney S James; David Xu; Peter Nakaji

doi:10.3171/2019.7.FocusVid.19148

Insular cavernous malformation resection through a minipterional, transsylvian approach

Neurosurg Focus Video. 2019 Jul 1;1(1):V26. doi: 10.3171/2019.7.FocusVid.19148. eCollection 2019 Jul.

Authors

Peyton L Nisson¹, Robert T Wicks², Xiaochun Zhao², Whitney S James³, David Xu², Peter Nakaji²

Affiliations

¹ College of Medicine, University of Arizona, Tucson.
² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and.
³ High Desert Surgery Center, Prescott, Arizona.

Abstract

Cavernous malformations of the brain are low-flow vascular lesions that have a propensity to hemorrhage. Extensive surgical approaches are often required for operative cure of deep-seated lesions. A 23-year-old female presented with a cavernous malformation of the left posterior insula with surrounding hematoma measuring up to 3 cm. A minimally invasive (mini-)pterional craniotomy with a transsylvian approach was selected. Endoscopic assistance was utilized to confirm complete resection of the lesion. The minipterional craniotomy is a minimally invasive approach that provides optimal exposure for sylvian fissure dissection and resection of many temporal and insular lesions. The video can be found here: https://youtu.be/9z6_EhU6lxs.

Keywords: cavernous malformation; insula; minimally invasive; minipterional; transsylvian; video.