Let's discuss the basic principles for a section of superficial supratentorial cavernous malformations, leading to seizures. This is a 16 year-old male with intractable epilepsy. MRI evaluation revealed a superficial left temporal cavernous malformation. Operative intervention was undertaken. Left front temporal craniotomy was completed. Neuronavigation was used. Small corticotomy exposed the surface of the malformation. The ear is located here. Here you can see the surface of the malformation through this small corticotomy. The gliotic margin of the malformation is also apparent. I used a bipolar forceps to disconnect the malformation from the surrounding gliotic margins. Obviously these lesions are relatively avascular. To maximize the chance of seizure freedom for supratentorial lesions, the gliotic margins have to also be removed. First, I focus on resection of the lesion. Here you can see the multilobulated mulberry appearance of the mass. After the lesion is removed, I will also excise the gliotic borders. Obviously this lesion faces the Sylvian fissure and the vessels within the fissure are carefully protected. Here are the gliotic margin of the malformation that would also be resected. Using the bipolar forceps, I coagulate these margins, emulsify them and remove them via suction device. Relatively normal appearing, white or yellow glistening white matter is not apparent. The gliotic surfaces here are also being removed. Again, this method is quite beneficial for maximizing seizure freedom after resection. Post-operative MRI, three months later demonstrated complete resection of the malformation. And this patient has been seizure-free for five years after his operation without any need for anticonvulsant medications. Thank you.
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