Mount Sinai West - New York

We report a 20-year-old male who presents for surgical resection of a dorsally exophytic medullary cavernous malformation incidentally diagnosed two and a half years earlier. The patient experienced a sudden severe headache consistent with a subarachnoid/intraventricular hemorrhage and a 30-minute “locked-in” episode 3-4 days later. He felt unable to move or feel anything from the neck down. The superior and dorsal aspects of the cavernous malformation were slightly more prominent, but no hemorrhage or brainstem injury was shown in the updated MRI.

We report a 54-year-old female who presented with an unsteady gait and a recent fall. MRI revealed a right Pons mass, suspected as a breast cancer metastatic disease. A craniotomy for a surgical biopsy was planned. The tumor was of few millimeters in diameter but relatively close to the Facial nuclei, Trigeminal sensory nuclei, and lemniscus pathways. Multimodal intraoperative monitoring (IOM) was used to avoid devastating intra-axial brainstem tumor surgical complications.