Tectal Cavernous Malformation that Manifested as Post-hemorrhagic Obstructive Hydrocephalus: A Surgical Case Report

Abstract

Brainstem cavernous malformations (BCMs) that present with hemorrhage are known to show a higher risk of rebleeding than that associated with cavernous malformations at other sites. We report a surgical case of a tectal cavernous malformation that manifested with post-hemorrhagic obstructive hydrocephalus in a 69-year-old-woman who presented with sudden headache and impaired consciousness. Computed tomography (CT) revealed tectal hemorrhage and acute hydrocephalus. Emergency ventricular drainage was performed; however, the patient's level of consciousness showed only slight improvement. CT performed on day 20 revealed a gradual increase in the size of the hemorrhagic area, suggestive of cavernous malformation-induced rebleeding. We performed microsurgical total resection of the midbrain mass via an occipital transtentorial approach, 5 weeks after onset. Postoperatively, the patient's level of consciousness and right hemiparesis recovered completely, her modified Rankin Scale score was 2, and she was independent at the time of discharge. Aggressive surgical resection is strongly recommended in patients with BCMs that manifest with hemorrhage, owing to the high risk of rebleeding and morbidity associated with this complication. This therapeutic strategy should be promptly considered using the appropriate approach based on the patient's health condition.