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Cavernous Malformations of the Brain (Cavernomas) - Surgical Treatment

Case Examples:

A cavernoma or cavernous malformation is a vascular abnormality of the central nervous system. It consists of a cluster of abnormal, dilated veins that have the propensity to bleed. When located in a critical area of the brain, bleeding from such a lesion can cause neurological damage. Cavernomas located in the brainstem have the highest likelihood of harming a patient. When they are surgically accessible, the option of having their cavernoma removed is given to our patients.
 

Case of a  60 Year old woman with progressive left-sided paralysis due to a brainstem cavernoma (red arrows on pre-operative MRI scans). She was unfortunately previously diagnosed as having had a tumor, and had received radiotherapy at another institution. At present, radiotherapy is not known to cure these lesions.

Pre-Treatment:

Saggital MRI showing a lesion in the midbrain (red arrow).

   

Coronal MRI showing the cavernoma in the midbrain (red arrow)

   

Axial MRI showing the midbrain cavernoma (red arrow)

   

Intra-Operative Views:

Use of intra-operative frameless stereotaxy system to approach the brainstem lesion. This device allows the surgeon to navigate inside the patient's brain under the guidance of the MRI scan. 

   

The frameless stereotaxy apparatus (yellow arrow) is interfaced with the operating microscope (blue arrow). This allows microsurgery to be carried out with simultaneous feedback from the patient's MRI scan.

   

View through the operating microscope illustrating some of the brain anatomy around the patient's cavernoma (blue arrow), and the lesion itself.

Post-Treatment:

Axial MRI scan showing that the lesion in the right brainstem has been removed.

   

Saggital MRI scan, also showing the lesion to have been removed.