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.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021