The contralateral transcingulate-transcallosal approach offers access to lesions seated in the deep medial frontal and parietal lobes with direct visualization of reliable anatomic landmarks. We describe the operative anatomy and technique for resecting pericallosal or periventricular cavernous malformations (CMs) presenting with intraventricular hemorrhage (IVH) or subarachnoid hemorrhage (SAH).

Three cases of pericallosal or periventricular CMs with IVH or SAH were treated using a contralateral transcingulate approach. Operative nuances related to patient positioning, anatomical corridors, and manipulation of the pericallosal and callosomarginal arteries were emphasized.

Complete resection was achieved in all three cases without intraoperative or postoperative complications. In each case, anatomical variations dictated adjustments to the surgical corridor to maximize safe exposure and minimize retraction.

The contralateral transcingulate approach provides a steeper angle of exposure for the resection of lesions in the wall of the lateral ventricle or protruding into the ventricle. This approach has unique benefits, when carefully planned with consideration of key anatomic landmark, over the transcallosal or transcortical approaches when indicated after careful anatomic consideration of lesion.