Introduction. Cavernous hemangiomas are benign vascular malformations with an estimated prevalence of 0.4-0.8%. Pontine cavernomas account for approximately 14-30% of intracranial cavernous malformations and represent a significant therapeutic challenge due to the high density of critical neural pathways within the brainstem. Although technically demanding, surgical treatment may be lifesaving in carefully selected cases. Case Report. A 23-year-old woman with multiple supratentorial cavernomas was initially managed conservatively due to mild clinical symptoms. Nine months later, she was found unresponsive following sudden onset of headache and vomiting. On admission, she was in deep coma and required immediate endotracheal intubation. Computed tomography revealed a large pontine hemorrhage with obstructive hydrocephalus, and magnetic resonance imaging confirmed a markedly enlarged cavernoma with acute bleeding. Given her critical neurological condition, emergent surgery was performed to evacuate the hematoma, resect the cavernoma, and relieve brainstem compression. With intensive postoperative care and five months of structured neurorehabilitation, the patient demonstrated gradual neurological improvement, including recovery of the swallowing reflex, initiation of speech, and significant motor recovery. At one-year follow-up, she achieved full cognitive recovery, normal communication abilities, and independent ambulation with residual hemiparesis. Conclusion. Despite the severity of presentation, this case illustrates that timely surgical intervention combined with meticulous neurocritical care and structured rehabilitation can enable meaningful functional recovery. With appropriate patient selection and modern microsurgical techniques, even critically ill patients with pontine cavernomas may achieve favorable long-term outcomes.
Azaric et al. (Wed,) studied this question.