gms | German Medical Science

Objective: Hemorrhagic, symptomatic cavernous malformations in the brainstem are difficult to access. We report the endoscopic transclival resection of a hemorrhagic brainstem cavernous malformation presenting to the ventral pons in a young woman.

Method: A 29-year-old woman presented with numbness and tingling of the right arm and leg and loss of fine motor control. Magnetic resonance imaging revealed a cavernoma in the ventromedial brainstem presenting to the ventral surface. A purely endoscopic, endonasal, transclival approach was used to resect this cavernoma.

Results: Postoperatively, she had no neurological deficits. The loss of fine motor control and the tingling disappeared. Postoperative course was uneventful. At her 6-week follow-up, she was in excellent conditions without any neurological deficits and had already restarted her full time job.

Conclusions: We have described the successful endoscopic, endonasal, transclival resection of a brainstem cavernous malformation presenting to the ventral surface of the pons. This patient had improvement in neurological symptoms after surgical resection without surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the brainstem previously requiring more invasive approaches. The endonasal transclival approach provides the most direct route to ventral pontine lesions. An early intervention in brainstem cavernous malformations might be indicated and can be performed with an individual approach considering the possible complications.