Brain Stem Cavernous Angiomas in Children

In an operative series of 20 patients under the age of 18 years with pathologically verified cavernous angiomas, 4 children had cavernous malformations in the pons or midbrain. These patients each presented with an acute or subacute neurologic deficit. None had family histories of similar lesions and only one had multiple lesions. Subtotal resection of the cavernous angioma was carried out in each case because of an inability to visualize and safely resect deep extensions of the malformation. One patient with a midbrain malformation suffered a permanently increased neurologic deficit postoperatively, but 2 of the patients are neurologically normal despite serious preoperative deficits. There has been no long-term rebleeding in these patients after follow-up of 2, 4, 7 and 10 years. These patients demonstrate the unpredictable natural history of certain cavernous malformations located in the brain stem.