Case report:Telovelar approach for a ruptured pontine cavernous malformation, in 11 years old patient.

Abstract

Ruptured cavernous malformations have a high risk of hemorrhage. It is a common condition in children. When this condition occurs, the chance of bleeding are about 4-60%. Even small hemorrhages can cause, severe neurological symptoms because of the high density of cranial nerve nuclei and fiber tracts within the brainstem. The goal of surgical treatment is not only the improvement of neurological symptoms, but also preservation of the patient’s quality of life.

Objective : To study hemorrhage in brain stem. Ruptured cavernous malformation in pediatric patient.

Methods : A report the surgical treatment of bleeding in the brain stem. In pediatric patient, 11 years old. Sunprasitthiprasong Hospital.

Results : A case of 11 years old female patient who presented after 5 months of conservative treatment with right sided lateral rectus palsy, right sided facial nerve palsy and loss of coordination. Diagnosis by MRI brain showed that patients with Ruptured cavernous malformation at right Pons. She was follow up which progressive neurological deficit in 3 weeks before surgery, the patient has worse symptoms which progressive of right facial nerve palsy and ataxic gait. CT brain found blood clot in brainstem larger. The cavernoma was total resected using a telovelar approach. The neurological deficit improved at follow up.

Conclusion : The choice of the surgical approach that allows the best exposure of the lesion is mandatory. In this case the lesion was evident on the surface of the brainstem and this facilitated its resection. Traction on the lesion and coagulation near the cranial nerves nuclei should be avoided. The objectives should be complete removal and improvement of neurological deficit.

Keywords : Pontine cavernous malformations, Telovelar approach