Surgical management for ponto-mesencephalic cavernoma: determining the brainstem safe entry zone – a case report

Abstract

Introduction: Cavernous malformations of the brainstem are groups of dilated sinusoidal tracts. The surgical excision of cavernous abnormalities of the brainstem is high-risk and challenging. Clinical manifestations due to mass effect or hemorrhage, as well as MRI studies, have become valuable factors in determining the most appropriate procedure for brainstem cavernoma to achieve the safe entry zone of the brainstem. Case: A case report on a brainstem cavernoma is reported here. A 10-year-old male with a pontomesencephalic cavernoma is presented. The cavernoma was surgically removed using a lateral supracerebellar infratentorial approach. The safe brainstem entry point was obtained with an intraoperative neuromonitoring (IOM) in spite of a neuronavigation devices. Post-op MRI images revealed a small residual mass. The patient had a favorable surgical outcome and was discharged on day 5. Conclusion: Recognizing a microsurgical anatomical landmark and an intraoperative neuromonitoring instrument will be critical in preventing neurologic function injury.