Endoscopic, Transnasal, Transclival Approach to Pontine Cavernomas: A Case Report and Review of the Literature

The authors report a case of a 21-year-old male who initially presented to the emergency department with right sided hemiparesis. Subsequent MRI showed hemorrhage from a venrally located pontine cavernoma and the patient underwent a retrosigmoid craniotomy. Post-op imaging revealed a large developmental venous anomaly (DVA) immediately adjacent to the resection cavity and appeared to reveal a gross total resection. Approximately ten months post-op the patient presented with acute severe right sided hemiparesis with MR imaging revealing re-hemorrhage within the prior resection cavity concerning for residual cavernoma with the DVA located immediately adjacent to the hemorrhage. Given the anterolateral location of the lesion and the need for visualization of the DVA on re-resection, an endoscopic, endonasal, transclival approach was taken. This approach provided direct visualization of the lesion and the DVA allowing for a gross total resection without injury to the DVA. This approach should be considered as an alternative to conventional neurosurgical approaches for these types of lesions in carefully selected patients