Giant pediatric brainstem cavernoma: illustrative case.

Area of Science:

• Neurosurgery
• Vascular Neurology
• Pediatric Neurosurgery

Background:

• Cerebral cavernous malformations are common vascular lesions, with brainstem locations posing significant management challenges due to critical anatomical structures.
• Brainstem cavernous malformations can lead to severe neurological deficits and hydrocephalus, necessitating careful consideration for intervention.

Purpose of the Study:

• To present a case study of a pediatric patient with a giant brainstem cavernous malformation.
• To describe an uncommon surgical approach and the use of intraoperative MRI for successful resection.

Main Methods:

• A 3-year-old male with a giant brainstem cavernous malformation presenting with hemiparesis and hydrocephalus.
• Surgical resection via a supracerebellar infratentorial approach.
• Utilization of intraoperative MRI to confirm complete tumor resection.

Main Results:

• The patient experienced recurrent hemorrhage and worsening hemiparesis despite initial steroid treatment.
• Complete resection of the brainstem cavernous malformation was achieved.
• Postoperative recovery resulted in the patient returning to near baseline neurological function.

Conclusions:

• An uncommon surgical approach, combined with advanced imaging like intraoperative MRI, can lead to excellent outcomes in pediatric patients with complex brainstem cavernous malformations.
• Careful planning and execution are crucial for managing these challenging lesions.