Resection of brainstem cavernous hemangioma with intraoperative neurophysiological monitoring: Case report and literature review

Cavernous hemangioma (CH) is one of the most common causes of brainstem hemorrhage. Because the tumor located at brainstem, the morbidity and mortality of these lesions are usually very high, and the treatments of them are also very difficult. With the development of neurosurgery technology and the emergence of intraoperative neurophysiological monitoring technology, the surgical operation of such lesions have been conducted more and more. Intraoperative neurophysiological monitoring (INM) was applied to clinical surgery for the first time in 1935. Because of the reliability and easy generalization, INM (intraoperative neurophysiological monitoring) have been applied more and more, and they have gradually changed the neurosurgery and neurosurgeons. In present case, the patient had lost the sense and movement of his right body for 7 days. CT scanning showed a roundish high-density lesion on the left side of the pons, MRI suggested hemorrhage of cavernous hemangioma. No cranial nerve dysfunction was found in physical examination. Intraoperative neurophysiological monitoring somatosensory evoked potential (SEP), auditory evoked potential (BAEP) were applied to protect the pyramidal tract, abduces nucleus and shallower genu of facial canal during the resection. The postoperative course was uneventful and the outcome was favorable. The pathological findings confirmed the diagnosis of Cavernous hemangioma. Another MRI was applied 1 month after the operation, which showed no relapse. We conclude that the operations of such lesions will be safer with the assistance of INM.