title: Contralateral interhemispheric approach to deep-seated cavernous malformations: surgical considerations and clinical outcomes in 31 consecutive cases.
abstract: BACKGROUND
  Deep-seated periventricular cavernous malformations of the basal ganglia or thalamus can be approached via an interhemispheric craniotomy.
  
  
  OBJECTIVE
  To determine surgical efficacy and clinical outcomes of the contralateral interhemispheric approach.
  
  
  METHODS
  Retrospective chart review was performed on patients undergoing an interhemispheric approach for the resection of deep-seated cavernous malformation by the senior author (R.F.S.) between 2005 and 2013. Demographic data and clinical outcomes were reviewed. Pre- and postoperative imaging were analyzed for lesion location, size, associated venous anomaly, proximity to ventricle, and presence of residual.
  
  
  RESULTS
  Twenty-one patients underwent a contralateral interhemispheric-transventricular approach, 7 patients had a contralateral interhemispheric-transcingulate approach and 3 patients had a contralateral interhemispheric-transchoroidal approach. Mean age was 40.1 years, and the majority were female (58.1%). Mean maximum cavernoma diameter was 1.97 cm, and 43.8% reached the surface of the ventricle. Average follow-up was 8.9 months, with complete resection achieved in 96.8% of patients. At last follow-up, 61.3% of patients remained stable and 29.0% had improved. Of the patients, 6.5% experienced transient weakness that resolved at last follow-up, and 1 patient (3.2%) had short-term memory problems. There were no surgical mortalities.
  
  
  CONCLUSIONS
  The contralateral interhemispheric approach is a safe, clinically well tolerated, and surgically efficacious approach to deep-seated cavernomas.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Chowdhry
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013788:Thalamus / Q000601:surgery; D016896:Treatment Outcome