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The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group<jats:italic>nl<\/jats:italic>). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group<jats:italic>yw<\/jats:italic>). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group<jats:italic>bg<\/jats:italic>). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group<jats:italic>ex<\/jats:italic>). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00701-021-04915-y","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T11:03:04Z","timestamp":1629457384000},"page":"2739-2754","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Microsurgical management of midbrain cavernous malformations: does lesion depth influence the outcome?"],"prefix":"10.1007","volume":"163","author":[{"given":"Caiquan","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2536-580X","authenticated-orcid":false,"given":"Helmut","family":"Bertalanffy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Souvik","family":"Kar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihito","family":"Tsuji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"4915_CR1","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1227\/NEU.0b013e3181ff9cde","volume":"68","author":"AA Abla","year":"2011","unstructured":"Abla AA, Lekovic GP, Turner JD, de Oliveira JG, Porter R, Spetzler RF (2011) Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. 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