Laser-assisted microsurgical extirpation of a brain stem cavernoma: case report

A 43-year-old woman presented with progressing signs of a space-occupying brain stem lesion. A computed tomographic scan revealed a hyperdense process located in the pons. Magnetic resonance imaging confirmed the lesion, which had a reticulated core of increased and decreased signal intensity. Vertebral angiography did not show any vascular supply of the process. The patient was operated upon in the lateral park bench position. The lesion, being located close to the exit zone of the trigeminal nerve, could be removed totally with incision of the brain stem and atraumatic vaporization of the tumor tissue with the CO2 laser. Despite the fact that the histopathological examination revealed a cavernous angioma the application of laser energy was judged to be extremely valuable for the surgical procedure. It was concluded that with proper selection of application mode and wattage the CO2 laser may be used for extirpation of vascularized lesions also especially when situated in or close to deep lying vital structures of the brain.