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Ruptured pontine cavernomas in infants: a report of two cases

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Abstract

Background

Cavernous malformations (CMs) are either congenital or acquired vascular lesions comprised of sinusoid spaces filled with either blood or its breakdown products. They possess a relatively reduced risk of hemorrhage, yet placement within the posterior fossa and especially the brainstem heightens their likelihood to rupture, making them a likely cause of permanent and debilitating neurological deficit, as well as a veritable surgical challenge. Although the incidence of rupture varies with age among reported case series, it is undoubtable that the severity of this occurrence is the highest while the brain is as its most vulnerable period, i.e. during infancy.

Case presentations

We present two patients, both female, 6.5- and 5-months-old respectively, who presented with brainstem hemorrhage from CM. They suffered from a sudden onset of hemiparesis and were subjected to surgical removal of their lesions and resulting hematomas. Both patients were discharged in a favorable neurological status and are currently alive and in good health.

Conclusion

Microsurgical treatment of brainstem CMs in infants is not only possible with minimal deficit, but also advisable if the lesions are symptomatic. Nevertheless, this requires substantial patience and experience to prevent significant loss of blood and injury to the structures of the posterior fossa. We argue that the safest method to prevent further damage from brainstem CM rebleed is to remove these lesions shortly after the initial hemorrhage.

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Authors and Affiliations

  1. Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania

    Ioan Alexandru Florian, Kinga Renata Kiss & Ioan Stefan Florian

  2. Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Ioan Alexandru Florian & Ioan Stefan Florian

  3. Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Teodora Larisa Timis

  4. The Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Ioana Berindan-Neagoe

  5. Functional Genomics and Experimental Pathology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania

    Ioana Berindan-Neagoe

Authors
  1. Ioan Alexandru Florian
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  2. Teodora Larisa Timis
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  3. Kinga Renata Kiss
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  4. Ioan Stefan Florian
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Correspondence to Ioan Alexandru Florian.

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Considering that the patients were underage, informed consent was obtained from the parents of all individual participants included in this study.

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Florian, I.A., Timis, T.L., Kiss, K.R. et al. Ruptured pontine cavernomas in infants: a report of two cases. Childs Nerv Syst 37, 1009–1015 (2021). https://doi.org/10.1007/s00381-020-04898-8

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  • DOI: https://doi.org/10.1007/s00381-020-04898-8

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