Abstract
Recurrent brainstem cavernoma is a challenging lesion due to the neurological risks associated with different surgical approaches. In this technical report, we present a 35-year-old female with a history of multiple brain cavernomas. She underwent midline suboccipital craniotomy and trans-fourth ventricle approach for resection of the brain stem cavernoma following two major bleeding episodes, one year prior to the presentation. Following the trans-labyrinthine infra-trigeminal approach, the patient recovered well postoperatively with a baseline neuro exam and was discharged to acute rehab on postoperative day 5 (POD5). The translabyrinthine approach is a safe and effective corridor for pontine or pontomedullary lesions in carefully selected patients. Appropriate selection of surgical approach (based on location), meticulous surgical technique, and intraoperative neuromonitoring help in maximizing surgical resection while minimizing neurological deficits.
Highlights
Recurrent brainstem cavernoma is a challenging lesion due to the neurological risks associated with different surgical approaches
Despite advances in micro-neurosurgical techniques, brainstem cavernoma (BC) continues to be a challenging lesion due to inherent risks associated with different surgical approaches [1,2,3,4]
Initial and recurrent hemorrhages from BC cause significant morbidity associated with the mass effect of the hematoma on critical and dense neural structures in the brainstem [5]
Summary
Despite advances in micro-neurosurgical techniques, brainstem cavernoma (BC) continues to be a challenging lesion due to inherent risks associated with different surgical approaches [1,2,3,4]. Our patient was a 35-year-old female with a history of multiple brain cavernomas She had a significant past medical history of seizures controlled with Keppra and carbamazepine. She has a history of smoking (0.5 pack for the last 10 years) and recreational drug abuse She underwent midline suboccipital craniotomy and the trans-fourth ventricle approach for the resection of brain stem cavernoma following two major bleeding episodes, one year prior to the presentation. She recovered well; she developed major bleeding episodes two months and one month ago with worsening neurological symptoms from a residual cavernoma. At the three and six-month follow-ups, MRI showed the stable appearance of the lesion with a gradual improvement in abducens nerve function (Figure 4)
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