Treatment of a Pontine Cavernoma With Laser Interstitial Thermal Therapy: Case Report

Abstract

BACKGROUND AND IMPORTANCE: Brainstem cavernomas represent a complex challenge for management. Lesions amenable to surgical resection meet criteria of either (1) are visible on the surface of the brainstem or (2) must be accessible through a brainstem safe entry zone. This case report illustrates a novel access to the brainstem for ablation of a pontine cavernoma. CLINICAL PRESENTATION: The patient is a 20-year-old woman. Initial presentation after a trauma revealed incidental finding of a hemorrhagic pontine cavernoma. The patient subsequently developed rehemorrhage of the cavernoma with associated symptoms of left-sided paresthesia, weakness, and gait imbalance. The patient underwent laser interstitial thermal therapy for ablation of the lesion. The laser cannula accessed the cavernoma using a suboccipital burr hole passing through the middle cerebellar peduncle. Postoperatively, the patient was noted to have diplopia secondary to R abducens palsy. Magnetic resonance imaging at the 19-month follow-up revealed a lesion measuring 1.3 × 1.2 cm down from preoperative measurement of 2.4 × 2.6 cm and continued improvement in diplopia. CONCLUSION: Although laser interstitial thermal therapy has previously been shown to be a treatment option for cavernomas, there is only 1 prior case report describing its use in the brainstem. Access of pontine cavernomas using the middle cerebellar peduncle is a safe approach. Further use of this technique is needed to better define the risks and benefits of this treatment option.