A 42-year-old male presented with declining general health and worsening neurological symptoms over a period of four years. The patient had at least three re-hemorrhages, the last two of which occurred within two months. On admission, patient was unable to walk or swallow and had to be treated for pneumonia prior to surgery.
Surgical Considerations And Approach
Considering the pontomedullary location of the lesion and close approximation to the floor of the fourth ventricle, a telovelar approach to the lesion was chosen. Intraoperative frameless navigation and brainstem monitoring was used to optimize the surgical corridor and to guaranty the safety of the patient.
Postoperatively, the patient's symptoms improved very quickly and he was transferred to our inpatient rehabilitation center within one week. Four months after surgery, patient was able to return to his previous life with only minor neurological deficits.
BELOW: Pre- and postoperative MRI studies Pontomedullary lesion with various stages of hemosiderin and blood products as seen on MRI. Note the cervical syrinx due to the mass effect of the cavernoma. As expected, the syrinx disappeared after surgery.