American Association of Neurological Surgeons | Insular cavernous malformation resection through a minipterional, transsylvian approach @AANSNeurosurgery | Uploaded August 2019 | Updated October 2024, 1 hour ago.
Peyton L. Nisson, BS,1 Robert T. Wicks, MD,2 Xiaochun Zhao, MD,2 Whitney S. James, MD, MHS,3 David Xu, MD,2 and Peter Nakaji, MD2

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


**Intro music: "Daybreak" by Graeme Rosner