The orbitozygomatic approach, developed for high-riding basilar artery bifurcation aneurysms, was ideal for midbrain cavernous malformation in the cerebral peduncle, interpeduncular fossa, and contralateral cerebral peduncle.
Brainstem microsurgery utilized navigation for submerged lesions, tractography for lesions near motor pathways, and lighted microinstruments for deep corridors.
The perception of the brainstem as an impenetrable monolith transformed as cavernous malformations below the pial surface were reached through safe entry zones.