Awake craniotomy with DES enabled safe removal of a deep thalamic cavernoma.

Transparietal approach allowed navigation around critical white matter tracts.

Postoperative MRI confirmed complete resection with tract preservation.

Significant functional recovery observed at 3-month follow-up.

Awake surgery with DES may expand indications for deep-seated CCMs.

Treating symptomatic deep-seated cerebral cavernous malformations (CCMs) is challenging due to surgical risks.

A 37-year-old man underwent awake craniotomy with direct electrical stimulation (DES) for excision of a left posterior thalamic CCM. A transcortical transventricular approach through the superior parietal lobe enabled safe navigation around critical associative and projection white matter tracts.

Postoperative MRI confirmed complete resection with preservation of major tracts, and the patient showed significant recovery at three months.

This case highlights the potential of awake surgery with DES as a safe and effective method for deep-seated CCMs traditionally deemed inoperable.

Cerebral cavernous malformation

Cavernoma

Tractography

Awake surgery

Thalamus

brain mapping

© 2025 The Authors. Published by Elsevier Masson SAS.