Frame-Based Stereotactic Surgery for a Deep-Seated Brain Cavernoma: A Case Report and Technical Video

Abstract Background Cerebral cavernomas are the second most common vascular malformation of the central nervous system. While microsurgical excision is standard for accessible symptomatic lesions, stereotactic radiosurgery (SRS) is preferred for deep-seated or inaccessible cavernomas due to the higher complication risk of open resection, despite carrying its own risks of delayed hemorrhage and radiation-induced injury. Frame-based stereotactic surgical excision may combine the targeting precision of SRS with the immediate efficacy of surgical resection while avoiding radiation exposure. Case Presentation: A 25-year-old female presented with a history of headache, photophobia, blurred vision, and intermittent vomiting. Examination revealed left lateral gaze limitation and bilateral papilledema. MRI demonstrated a 15×20×24 mm intra-axial lesion in the left thalamic region extending to the left cerebral peduncle, causing obstructive hydrocephalus, initially favored as glioma. After endoscopic third ventriculostomy and an inconclusive endoscopic biopsy, stereotactic partial excision was performed using a novel 3D-printed stereotactic frame. Intraoperative findings and histopathology confirmed cavernoma rather than glioma. The procedure was uneventful, with no hemorrhage on postoperative imaging, and the patient was discharged on postoperative day two with an intact neurological examination. Conclusion Frame-based stereotactic surgical excision using this novel low-cost stereotactic system enabled safe, precise debulking of a deep-seated, rare thalamic-peduncular cavernoma, achieving diagnostic confirmation and symptomatic mass-effect reduction without complications. This approach may offer a viable alternative for deep, eloquently located cavernomas where open microsurgery carries excessive risk and SRS risks incomplete treatment and radiation side effects, warranting further evaluation in larger case series.