IJCNMH ARCpublishing

Issue: Issue 1 (2014)

Case Report

Ventral midbrain cavernoma, a surgical challenge: case report and review

Pedro Alberto Silva, António Vilarinho, Fernando Silveira, and Rui Vaz
Background: Once considered surgically unapproachable, the brainstem remains a challenging field for neurosurgeons, despite technical advances and better anatomical understanding. Particularly in this location, vascular malformations such as cavernomas have the potential to induce severe neurological deficits and/or death.

Case Report: We report the uncommon case of a 39 year-old male who presented with diplopia, abnormal pupillary motor responses, and slight brachiofacial palsy. Imaging studies revealed a left ventral midbrain hemorrhage and subjacent cavernoma. An approach was performed to the lesion through pterional craniotomy and a pretemporal route to the interpeduncular fossa. A pial incision was directed by the presence of gliotic tissue and the cavernoma was excised, with complete reversal of symptoms.

Conclusions: We review the available literature and debate the surgical indication, the advantages, and the difficulties of this approach for cavernomas in this area. This case confirms there are relatively safe entry zones for the ventral midbrain, and that successful surgery is possible in this location with the right reference points.

Keywords: Cavernoma, Midbrain, Ventral, Microneurosurgery, Motor evoked potentials, Surgery

International Journal of Clinical Neurosciences and Mental Health 2014; 1:4

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