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How I do it: surgical resection of a subcallosal gyrus cavernous malformation by a contralateral anterior interhemispheric approach

  • How I Do it - Vascular Neurosurgery - Other
  • Published:
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Abstract

Background

Cavernous malformation (CM) of the subcallosal gyrus is extremely rare, and due to its close relationship with the lateral ventricle’s frontal horn, it may be misdiagnosed as caudate head or ventricle CM.

Method

This video shows a rare case of subcallosal gyrus CM successfully cured by a contralateral anterior interhemispheric approach.

Conclusion

We hope this case provides new insights into anatomical knowledge and surgical approach techniques for subcallosal lesions.

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References

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Acknowledgements

The authors thank Jianbin Shi for the brain imaging processing and Geng Xu for the intraoperative electrophysiological monitoring support.

Funding

This study was sponsored by the Shanghai Rising-Star Program (18QA1400900 to J.S.).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital of Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Zixiao Yang,  Xin Zhang , Jianping Song & Wei Zhu

  2. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Zixiao Yang,  Xin Zhang , Jianping Song & Wei Zhu

  3. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Zixiao Yang,  Xin Zhang , Jianping Song & Wei Zhu

  4. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China

    Zixiao Yang,  Xin Zhang , Jianping Song & Wei Zhu

Authors
  1. Zixiao Yang
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  2. Xin Zhang
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  3. Jianping Song
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  4. Wei Zhu
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Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Patient consent

The patient gave approval for publication of this case.

Conflict of interest

The authors declare no competing interests.

Additional information

Key points

1. Knowing the anatomy of the subcallosal structure is essential.

2. The subcallosal area is bounded by the anterior and posterior subcallosal sulcus.

3. The subcallosal gyrus is not a cortical convolution but is the ventral continuation of the transparent septum posterior to the posterior subcallosal sulcus.

4. Meticulous preoperative radiological analysis is critical for identifying the actual location of the subcallosal gyrus lesion.

5. A neuronavigation system is essential for tailored craniotomy design and tiny lesion localization.

6. The contralateral anterior interhemispheric approach can provide a straightforward surgical trajectory to the ipsilateral subcallosal area and subcallosal gyrus.

7. The risk of contralateral normal hemisphere impingement could be minimized by using gravity-assisted autoretraction.

8. To minimize the risk of cognitive impairment, care should be taken to protect the medial surface of the bilateral frontal hemispheres, the corpus callosum, and the AC.

9. Sharp dissection was the key step during the tedious interhemispheric dissection to avoid violating the pia mater.

10. The CM should be removed in an en bloc fashion for a cure whenever possible.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Zixiao Yang and Zhang Xin are the first two authors contributed equally to this work.

This article is part of the Topical Collection on Vascular Neurosurgery - Other

Supplementary Information

Below is the link to the electronic supplementary material.

This video illustrates a subcallosal gyrus cavernous malformation successfully resected by the contralateral anterior interhemispheric approach (MP4 95916 KB)

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Yang, Z., Zhang , ., Song, J. et al. How I do it: surgical resection of a subcallosal gyrus cavernous malformation by a contralateral anterior interhemispheric approach. Acta Neurochir 164, 2581–2585 (2022). https://doi.org/10.1007/s00701-021-04917-w

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  • DOI: https://doi.org/10.1007/s00701-021-04917-w

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