Brainstem cavernoma: A case report with literature review

Rajan Kumar Sharma , Ahmed Asiri, Yashiro Yamada, Tsukasa Kawase, Yoko Kato

Rajan Kumar Sharma
Department of Neurosurgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal and Fellow, Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan. Email:

Ahmed Asiri
Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia

Yashiro Yamada
Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan

Tsukasa Kawase
Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan

Yoko Kato
Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan
Online First: April 01, 2019 | Cite this Article
Sharma, R., Asiri, A., Yamada, Y., Kawase, T., Kato, Y. 2019. Brainstem cavernoma: A case report with literature review. Indonesian Journal of Neurosurgery 2(1). DOI:10.15562/ijn.v2i1.29

Introduction: Brainstem cavernomas (BC) are benign vascular malformations comprising about 5-18% of intracranial vascular malformations and generally present with focal neurological deficit. Hemorrhagic episodes caused by brainstem CMs can result in serious symptoms (such as hemiplegia, respiratory dysfunction, and disrupted consciousness) due to their precarious locations. Surgical treatment of BC was first done by Dandy in 1932, who resected a brainstem hematoma after cavernous angioma bleed. In the past, these lesions were inoperable, but with the advancement and the use of newer modalities, their management has become precise and reduce morbidity and mortality.

Case presentation: Here we describe a 79-year-old male who presented with complaints of right-sided weakness with Medical Research Council grade IV/V power and features of left oculomotor nerve palsy. Imaging studies showed left-sided cavernous malformation with hemorrhage. Patient after proper evaluation and using newer tools like navigation and intraoperative nerve monitoring surgery was performed. A posterior petrosal approach was done for the patient. There were improvements in weakness and eye signs postoperatively.

Conclusion: We propose that radical resection of the cavernoma while preserving the surrounding normal brainstem during the subacute phase is the best surgical strategy in elderly patients.

Keywords: brainstem cavernoma, posterior petrous approach, safe entry zones


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