Treatment of a Pontine Cavernoma with Laser Interstitial Thermal Therapy: Case Report

Background: Brainstem cavernomas represent a complex challenge for management. Lesions amenable to surgical resection meet criteria of either (1) are visible on the surface of the brainstem or (2) must be accessible via a brainstem safe entry zone. This case report illustrates a novel access to the brainstem for ablation of a pontine cavernoma.

Clinical Presentation: Patient is a 20-year-old female. Initial presentation following a trauma revealed incidental finding of a hemorrhagic pontine cavernoma. Patient subsequently developed rehemorrhage of the cavernoma with associated symptoms of left-sided paresthesia, weakness, and gait imbalance. Patient underwent laser interstitial thermal therapy (LITT) for ablation of the lesion. The laser cannula accessed the cavernoma via a suboccipital burr hole passing through the middle cerebellar peduncle. Postoperatively, patient was noted to have diplopia secondary to Abducen's palsy. Magnetic resonance imaging at 19-month follow-up revealed a lesion measuring 1.3 cm × 1.2 cm down from preoperative measurement of 2.4 cm × 2.6 cm, as well as continued improvement in diplopia.

Conclusion: While LITT has previously been shown to be a treatment option for cavernomas, there is only one prior case report describing its use in the brainstem. Access of pontine cavernomas via the middle cerebellar peduncle is a safe approach. Further, use of this technique is needed to better define the risks and benefits of this treatment option.

Publication History

Article published online:
12 February 2021