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Christopher H. Comey, Douglas Kondziolka and Howard Yonas

spasticity in both legs. Magnetic resonance (MR) imaging demonstrated recurrent hemorrhage in the left cerebellar hemisphere ( Fig. 1 lower ). The appearance of the midbrain cavernous malformation was unchanged. Because of her propensity for recurrent hemorrhage, the patient underwent resection of the hematoma as well as a portion of the venous angioma along with its cerebellar territory of drainage. Although she tolerated the procedure well, she continues to have profound leg weakness and has made only a partial recovery. Analysis of her CT and MR studies revealed

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Marjorie C. Wang, Ken R. Winston and Robert E. Breeze

its output. 1, 3, 6, 7, 10, 12, 13, 16 Others have suggested involvement of the cerebellar hemispheres, particularly the left one, 25 and functional imaging studies have even been used to link cerebellar mutism with altered function in the cerebral cortex. 14 We present a case of mutism following surgery in a patient with a midbrain cavernous malformation. Analysis of this case further elucidates the anatomical basis for cerebellar mutism. Case Report History This 14-year-old, right-handed, previously healthy boy presented with a severe headache

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associated with a midbrain cavernous malformation Marjorie C. Wang Ken R. Winston Robert E. Breeze March 2002 96 3 607 610 10.3171/jns.2002.96.3.0607 Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue of the dura mimicking the presentation of an acute subdural hematoma Pablo Goetz Jesus Lafuente Tomas Revesz Malcolm Galloway Ahmet Dogan Neil Kitchen March 2002 96 3 611 614 10.3171/jns.2002.96.3.0611 Bilateral thalamic deep brain stimulation for the treatment of head tremor Caglar Berk

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Yoshikazu Kusano, Yuichiro Tanaka, Hiroshi Takasuna, Naomichi Wada, Tsuyoshi Tada, Yukinari Kakizawa and Kazuhiro Hongo

mutism after posterior fossa surgery in children . Neurosurgery 37 : 894 – 898 , 1995 19 Wang MC , Winston KR , Breeze RE : Cerebellar mutism associated with a midbrain cavernous malformation. Case report and review of the literature . J Neurosurg 96 : 607 – 610 , 2002

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Patricia L. Robertson, Karin M. Muraszko, Emiko J. Holmes, Richard Sposto, Roger J. Packer, Amar Gajjar, Mark S. Dias and Jeffrey C. Allen

associated with cerebellar mutism . Pediatr Rehabil 1 : 41 – 44 , 1997 71 van Dongen HR , Catsman-Berrevoets CE , van Mourik M : The syndrome of ‘cerebellar’ mutism and subsequent dysarthria . Neurology 44 : 2040 – 2046 , 1994 72 Volcan I , Cole GP , Johnston K : A case of muteness of cerebellar origin . Arch Neurol 43 : 313 – 314 , 1986 73 Wang MC , Winston KR , Breeze RE : Cerebellar mutism associated with a midbrain cavernous malformation. Case report and review of the literature . J Neurosurg 96 : 607 – 610 , 2002 74

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Giuliano Giliberto, Desiree J. Lanzino, Felix E. Diehn, David Factor, Kelly D. Flemming and Giuseppe Lanzino

. A: Schematic illustration of the surface anatomy of the dorsal brainstem . B: Schematic illustration of the arterial (left) and venous (right) brainstem anatomy. F ig . 14. Axial view of the midbrain showing the surgical route through the lateral mesencephalic sulcus, covered by the lateral mesencephalic vein (blue circle) . This safe entry zone allows a trajectory (arrow) of approach between the substantia nigra (SN) and the medial lemniscus (ML) posterior to the cerebral peduncle. Surgical Approaches to the Posterior Midbrain. Cavernous

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Wael F. Asaad, Brian P. Walcott, Brian V. Nahed and Christopher S. Ogilvy

. Neurosurgery 38 : 662 – 670 , 1996 48 Quinones-Hinojosa A , Alam M , Lyon R , Yingling CD , Lawton MT : Transcranial motor evoked potentials during basilar artery aneurysm surgery: technique application for 30 consecutive patients . Neurosurgery 54 : 916 – 924 , 2004 49 Quinones-Hinojosa A , Lyon R , Du R , Lawton MT : Intraoperative motor mapping of the cerebral peduncle during resection of a midbrain cavernous malformation: technical case report . Neurosurgery 56 : 2 Suppl E439 , 2005 50 Reisch R , Bettag M , Perneczky A

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Cheng-Chia Lee, David Hung-Chi Pan, Wen-Yuh Chung, Kang-Du Liu, Huai-Che Yang, Hsiu-Mei Wu, Wan-Yuo Guo and Yang-Hsin Shih

, Derksen PT , : Cavernous malformations of the brainstem: experience with 100 patients . J Neurosurg 90 : 50 – 58 , 1999 23 Quinones-Hinojosa A , Lyon R , Du R , Lawton MT : Intraoperative motor mapping of the cerebral peduncle during resection of a midbrain cavernous malformation: technical case report . Neurosurgery 56 : 2 Suppl E439 , 2005 24 Robinson JR , Awad IA , Little JR : Natural history of the cavernous angioma . J Neurosurg 75 : 709 – 714 , 1991 25 Sandalcioglu IE , Wiedemayer H , Secer S , Asgari S

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third ventriculostomy and removal of midbrain cavernous malformation William T. Couldwell M.D., Ph.D. 1 2013 34 v1supplement 1 1 10.3171/2013.V1.FOCUS12348 2013.V1.FOCUS12348 Microsurgical resection of giant intraventricular meningioma James K. Liu M.D. 1 2013 34 v1supplement 1 1 10.3171/2013.V1.FOCUS12352 2013.V1.FOCUS12352 Interhemispheric transcallosal approach for resection of intraventricular central neurocytoma James K. Liu M.D. 1 2013 34 v1supplement 1 1 10.3171/2013.V1.FOCUS12353 2013.V1.FOCUS12353 Modified one-piece extended transbasal approach for

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William T. Couldwell

Symptomatic brain stem cavernous malformations often present the dilemma of choosing an approach for their resection. Superior midline midbrain lesions are in a particularly challenging location, as they are less accessible via traditional lateral or posterior approaches. The author presents a case of a young woman who presented with a symptomatic cavernous malformation with surface presentation to the floor of the third ventricle. The lesion was causing sensory symptoms from local mass effect and hydrocephalus from occlusion of the Aqueduct of Sylvius. An approach was chosen to both perform a third ventriculostomy and remove the cavernous malformation. Through a right frontal craniotomy, a transcallosal–transforaminal approach was used to perform a third ventriculostomy. Through the same callosal opening, a subchoroidal approach was performed to provide access the cavernous malformation. The details of the procedure and nuances of technique are described in the narration.

The video can be found here: http://youtu.be/zKKnehp7l2c.