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Primary Intracranial Brainstem Malignant Melanoma: A Technical Case Report
Margaret McGrath1, Samuel Emerson1, Varadaraya Satyanarayan Shenoy1
1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Operative Neurosurgery (Hagerstown, Md.)
|July 15, 2022
Summary
Primary pontine malignant melanoma (PIMM) is exceptionally rare. This report details the second case of brainstem PIMM, highlighting successful surgical resection and the need for further research.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Primary intracranial malignant melanomas (PIMMs) are rare, accounting for 1% of melanomas and 0.07% of intracranial tumors.
- PIMMs can occur in various intracranial locations, with only one prior report of a brainstem PIMM.
- This study presents the second documented case of primary pontine malignant melanoma and its management.
Observation:
- A 40-year-old male presented with hemiparesis, diplopia, and dysarthria.
- MRI revealed a hemorrhagic, enhancing lesion in the left pons with associated edema.
- The lesion was surgically resected via a transpetrosal approach.
Findings:
- Pathology confirmed malignant melanoma, immunopositive for BRAF V600E mutation.
- Comprehensive oncological workup excluded other metastatic sites, confirming a primary brainstem origin.
- The patient was diagnosed with primary pontine malignant melanoma.
Implications:
- Microsurgical resection led to significant clinical improvement in this rare case of brainstem PIMM.
- This case underscores the possibility of successful surgical intervention for PIMM in challenging locations.
- Further studies with larger patient cohorts and extended follow-up are essential to establish optimal treatment strategies for brainstem PIMMs.
