Surgery for the cavernous angioma in the brainstem

Abstract Surgical treatment of the cavernous angioma in the brainstem needs careful consideration of indication, timing of surgery, and selection of the optimal surgical approach. We report three cases of cavernous angioma in the brainstem treated surgically. Case 1 is a 54-year-old woman presented with hemorrhage in the pons. As she deteriorated with repeated hemorrhage, surgical resection was done via the fourth ventricle. Postoperatively, she became alert and showed no additional neurological deficits. Case 2 is a 44-year-old woman presented with hematoma in the right side of the midbrain. As she suffered repeated hemorrhage extending to the right thalamus, resulting in deterioration and left hemiparetic, direct surgery was performed via the right subtemporal approach. Postoperatively, she became alert and the hemiparesis improved. Case 3 is a 49-year-old man presented with repeated hemorrhage in the medulla oblongata. Neuroimagings disclosed the cavernous angioma was associated with a venous malformation in the vicinity. Only the cavernous angioma was surgically resected via the fourth ventricle. Postoperative course was uneventful, and he returned to his job 3 weeks after surgery. Clinically manifested cavernous angioma due to repeated hemorrhage needs surgical resection. Optimal surgical approach should be selected so as the normal vital structures are not compromised. Careful dissection is also mandatory not to press and damage the surrounding vital structures.