Microsurgical Resection of a Midbrain Cavernous Malformation via the Paramedian Supracerebellar Infratentorial Translateral Mesencephalic Sulcus Approach Using the Dynamic Lateral Semisitting Position: Two-Dimensional Operative Video with 3-Dimensional Anatomical Models

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.