Background

Cavernous malformations (CMs) are either congenital or acquired vascular lesions comprised of sinusoid spaces filled with either blood or its breakdown products. They possess a relatively reduced risk of hemorrhage, yet placement within the posterior fossa and especially the brainstem heightens their likelihood to rupture, making them a likely cause of permanent and debilitating neurological deficit, as well as a veritable surgical challenge. Although the incidence of rupture varies with age among reported case series, it is undoubtable that the severity of this occurrence is the highest while the brain is as its most vulnerable period, i.e. during infancy.

Case presentations

We present two patients, both female, 6.5- and 5-months-old respectively, who presented with brainstem hemorrhage from CM. They suffered from a sudden onset of hemiparesis and were subjected to surgical removal of their lesions and resulting hematomas. Both patients were discharged in a favorable neurological status and are currently alive and in good health.

Conclusion

Microsurgical treatment of brainstem CMs in infants is not only possible with minimal deficit, but also advisable if the lesions are symptomatic. Nevertheless, this requires substantial patience and experience to prevent significant loss of blood and injury to the structures of the posterior fossa. We argue that the safest method to prevent further damage from brainstem CM rebleed is to remove these lesions shortly after the initial hemorrhage.

中文翻译：

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婴儿破裂性桥脑海绵状瘤：两例报道

背景

海绵状畸形（CMs）是先天性或后天性血管病变，由充满血液或其分解产物的正弦空间组成。它们具有相对较低的出血风险，但是放置在后颅窝，特别是脑干内，增加了其破裂的可能性，使其成为永久性和使人衰弱的神经功能缺损的原因，并且确实对外科手术提出了挑战。尽管在报告的病例系列中破裂的发生率随年龄的变化而变化，但是毫无疑问的是，当大脑处于最脆弱的时期（即婴儿期）时，这种破裂的严重程度最高。

案例介绍

我们介绍了两名患者，分别是女性，分别为6.5个月和5个月大，他们因CM出现脑干出血。他们患有偏瘫的突然发作，并通过手术切除了病变并导致了血肿。两名患者均出院，神经系统状况良好，目前还活着并且身体健康。

结论

婴儿脑干CM的显微手术治疗不仅可以使缺陷最少，而且如果病变是有症状的，也是明智的。但是，这需要足够的耐心和经验，以防止血液大量流失和后颅窝结构的损伤。我们认为，防止脑干CM再出血引起的进一步损害的最安全方法是在初次出血后不久去除这些病变。