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XXII Congreso Nacional de la Sociedad Española de Neurocirugía
Toledo, 16-18 Mayo 2018
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V0430 - BRAINSTEM CAVERNOMA WITH HEMATOMA, TRANSSYLVIAN MICROSURGICAL TREATMENT

J. Olabe Goxencia and J. Olabe Jauregui

Grupo Juaneda, Grupo Quirón, Baleares, Spain.

Objectives: To describe the microsurgical treatment of brainstem cavernoma via the transilvian approach.

Methods: 22 year old patient that is admitted after sudden headache followed by left hemisensitive syndrome in face and body with right hemiparesis (4/5 motor weakness) and right mydriasis iwith GCS 15. Brain CT and MRI demonstrate right mesencephalic hemorrhage with relationship to lesion compatible with cavernoma. Conservative treatment is initiated but new sudden headache occurs with small rebleed that can be observed in brain imaging. Microsurgical excision is recommended via right pterional transylvian vs pretemporal approach.

Results: Via standard right pterional transylvian approach the anterior brainstem is exposed, with a small corticectomy the hematoma is entered and evacuated followed by resection of the cavernoma. Immediate improvement of the motor evoked potentials and somatosensorial potentials was appreciated. The postoperative period was uneventful with improvement of the neurological deficits.

Conclusions: Microsurgical excision of brainstem cavernomas must be considered as a treatment option in cavernomas of eloquent areas such as the brainstem especially in young patients with rebleed of the lesion.