Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report
Brain stem cavernomas are exceedingly rare in pediatric populations, with limited literature addressing their natural history, treatment guidelines, and counseling. We report the case of a 5-year-old girl presenting with acute neurological symptoms, including diplopia, gait ataxia, headache, and alt...
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2025-04-01
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| author | Matthias Krause Armin-Johannes Michel Johannes Koch Johann Gradl Johannes A. R. Pfaff Christoph J. Griessenauer Lorenz Stana-Hackenberg |
| author_facet | Matthias Krause Armin-Johannes Michel Johannes Koch Johann Gradl Johannes A. R. Pfaff Christoph J. Griessenauer Lorenz Stana-Hackenberg |
| author_sort | Matthias Krause |
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| description | Brain stem cavernomas are exceedingly rare in pediatric populations, with limited literature addressing their natural history, treatment guidelines, and counseling. We report the case of a 5-year-old girl presenting with acute neurological symptoms, including diplopia, gait ataxia, headache, and altered consciousness. Initial imaging revealed obstructive hydrocephalus caused by a hemorrhagic lesion near the pineal region. After emergency external ventricular drainage (EVD), most symptoms resolved except for diplopia. A subsequent MRI suggested a space-occupying hemorrhagic cyst in the tectal lamina, leading to endoscopic third ventriculostomy (ETV). During ETV, a large hemorrhagic mass at the aqueduct entrance was identified but not removed due to its fragility. Following ETV, the patient improved rapidly and was discharged. However, she was readmitted with recurrent symptoms and altered consciousness. An emergency MRI indicated a progressive hemorrhagic mass lesion compressing the midbrain, necessitating surgical intervention. The patient underwent suboccipital craniotomy using a telovelar approach. The intraoperative findings included cavernoma-like tissue within the aqueduct, which was successfully resected. Histopathology confirmed hemorrhagic and angiomatous tissue, excluding a primary brain tumor. Postoperatively, the patient showed significant, progressive neurological improvement, with mild internuclear strabism, trunk ataxia, and fatigue at the last follow-up. Six months later, a follow-up MRI and cerebral angiography showed no cavernoma remnants but identified a midbrain deep venous anomaly. This case underscores the feasibility of the microsurgical resection of midbrain cavernomas in symptomatic pediatric patients, highlighting the importance of the thorough assessment of atypical hemorrhagic midbrain lesions to exclude rare vascular malformations from differential diagnoses. |
| format | Article |
| id | doaj-art-2f501a81f52048ea99a2a7dc4938fa67 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-04-01 |
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| series | Children |
| spelling | doaj-art-2f501a81f52048ea99a2a7dc4938fa672025-08-20T03:47:48ZengMDPI AGChildren2227-90672025-04-0112556410.3390/children12050564Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case ReportMatthias Krause0Armin-Johannes Michel1Johannes Koch2Johann Gradl3Johannes A. R. Pfaff4Christoph J. Griessenauer5Lorenz Stana-Hackenberg6Department of Neurosurgery, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of Pediatric Surgery, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of General Pediatrics, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of Radiology, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of Neurosurgery, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of Neurosurgery, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaDepartment of General Pediatrics, Paracelsus Medical Private University Salzburg, 5020 Salzburg, AustriaBrain stem cavernomas are exceedingly rare in pediatric populations, with limited literature addressing their natural history, treatment guidelines, and counseling. We report the case of a 5-year-old girl presenting with acute neurological symptoms, including diplopia, gait ataxia, headache, and altered consciousness. Initial imaging revealed obstructive hydrocephalus caused by a hemorrhagic lesion near the pineal region. After emergency external ventricular drainage (EVD), most symptoms resolved except for diplopia. A subsequent MRI suggested a space-occupying hemorrhagic cyst in the tectal lamina, leading to endoscopic third ventriculostomy (ETV). During ETV, a large hemorrhagic mass at the aqueduct entrance was identified but not removed due to its fragility. Following ETV, the patient improved rapidly and was discharged. However, she was readmitted with recurrent symptoms and altered consciousness. An emergency MRI indicated a progressive hemorrhagic mass lesion compressing the midbrain, necessitating surgical intervention. The patient underwent suboccipital craniotomy using a telovelar approach. The intraoperative findings included cavernoma-like tissue within the aqueduct, which was successfully resected. Histopathology confirmed hemorrhagic and angiomatous tissue, excluding a primary brain tumor. Postoperatively, the patient showed significant, progressive neurological improvement, with mild internuclear strabism, trunk ataxia, and fatigue at the last follow-up. Six months later, a follow-up MRI and cerebral angiography showed no cavernoma remnants but identified a midbrain deep venous anomaly. This case underscores the feasibility of the microsurgical resection of midbrain cavernomas in symptomatic pediatric patients, highlighting the importance of the thorough assessment of atypical hemorrhagic midbrain lesions to exclude rare vascular malformations from differential diagnoses.https://www.mdpi.com/2227-9067/12/5/564midbrain cavernomaendoscopic third ventriculostomymicrosurgical resectiontectal cavernoma |
| spellingShingle | Matthias Krause Armin-Johannes Michel Johannes Koch Johann Gradl Johannes A. R. Pfaff Christoph J. Griessenauer Lorenz Stana-Hackenberg Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report Children midbrain cavernoma endoscopic third ventriculostomy microsurgical resection tectal cavernoma |
| title | Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report |
| title_full | Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report |
| title_fullStr | Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report |
| title_full_unstemmed | Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report |
| title_short | Treatment of a Large Hemorrhagic Midbrain Cavernoma Within the Silvian Aqueduct in a Five-Year-Old Girl—A Case Report |
| title_sort | treatment of a large hemorrhagic midbrain cavernoma within the silvian aqueduct in a five year old girl a case report |
| topic | midbrain cavernoma endoscopic third ventriculostomy microsurgical resection tectal cavernoma |
| url | https://www.mdpi.com/2227-9067/12/5/564 |
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