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Background: Reports showed the intimate association of the developmental venous anomaly with infra-tentorial cavernous malformation. This association has several clinical and surgical implications, sometimes this association will be a surgical challenge and affect the selection of the safest approach to the lesion. Surgery for infratentorial cavernoma is indicated for accessible symptomatic lesion only.
Case scenario: we present a case of deep cerebello-pontine CM adjacent to the lateral recess, presented with acute clinical deterioration to the emergency department of the Neurosurgery Teaching Hospital in Baghdad, Iraq, with the only possible approach was Trans-cerebellar approach because of the medial location of the associated DVA.
Conclusion: The association of developmental venous anomaly with infratentorial cavernous malformation has a pivotal role in selection the most appropriate and safe surgical approach which should be based upon the individualized patient anatomy and the location of the target lesion.