Brain Tumor Res Treat.  2021 Oct;9(2):87-92. 10.14791/btrt.2021.9.e15.

Contralateral Interhemispheric Transcallosal Approach for Thalamic Cystic Cavernous Malformation

• Jang TG
• Cha SH
• Cho WH

• KMID: 2522225
• DOI: http://doi.org/10.14791/btrt.2021.9.e15

Abstract

A 42-year-old man presented with a headache and right hemiparesis and was found to have a cystic mass with a calcified mural nodule in the left thalamus. Because the thalamus is surrounded by vital neurovascular structures, the surgical approach to thalamic lesions can be challenging. We decided to remove the mass for decompression and pathological diagnosis. The mass was removed through a contralateral interhemispheric transcallosal transchoroidal approach with less retraction and parenchymal injury than other approaches to avoid brain retraction and cortical injury. The pathological diagnosis was cavernous malformation. Temporary worsening of the preoperative hemiparesis was recovered over two months following surgery. Tolerable thalamic pain syndrome remained. Here, we report a rare case of thalamic cavernous malformation with a favorable outcome through a contralateral surgical approach.

Keyword

Cysts; Cavernous hemangioma; Thalamus

Figure

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  Fig. 1 Preoperative radiologic findings. A: CT scanning shows a cystic mass with peripheral calcified nodule at left thalamus and hydrocephalus. B: T2-weighted MR axial image shows a lobulated cyst with fluid-fluid level and obstructive hydrocephalus. C: T1-weighted MR axial image shows a lobulated cyst with peripheral high signal mass. D: T1-weighted enhanced MR axial image shows subtle enhanced cystic mass at left thalamus.

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  Fig. 2 Postoperative radiologic findings. A: Surgical trajectory of contralateral interhemispheric transcallosal approach (red arrows) on T2-weighted MR coronal image. B: Postoperative CT coronal image shows contralateral callosotomy and ventricular catheter through the surgical route. C and D: Postoperative follow-up MRI shows removal of solid component and disappearance of mass effect without any neurovascular injury.

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  Fig. 3 Operative and pathologic findings. A: The floor of left lateral ventricle (asterisk) was upward displaced by thalamic mass. B: Gliosis and hemosiderin deposits are seen along the margin of cavernous malformation. C: Microscopic finding shows some abnormal shaped vessels that are consistent with cavernous malformation (hematoxylin & eosin, ×100).

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