Surgical Treatment of Pontine Cavernous Hemangioma

ABSTRACT

In general, surgical approaches to intrinsic lesions of the brain stem are problematic. We encountered two cases of pontine cavernous hemangioma in which successful removal was possible with the help of intraoperative electrophysiological monitoring. During surgery, somatosensory and auditory evoked potentials, were subject to intraoperative bimodal monitoring. Before the removal of hemangiomas, monopolar stimulation and monitoring of the facial EMG identified facial colliculus on the floor of the fourth ventricle. During and after surgery, there was some increase in the amplitude of BAEP and SSEP, and the authors recognized that post-surgical E-P information correlated well with surgical outcome. We observed marked improvement of preoperative neurological deficits, and follow-up brain MRI showed that the hemangiomas had been completely removed. These favorable results demonstrate the usefulness of intraoperative electrophysiological monitoring, and indicate the appropriacy of more aggressive surgical treatment of symptomatic cavernous hemangioma of the brain stem.