Microsurgical resection of a huge pontine cavernoma with bulbar disturbance

Abstract

Pontine cavernous malformations are rare vascular lesions that carry a significant risk of hemorrhage and
neurological deficits because of their location within the brainstem. We describe the case of a young patient
who presented with bulbar symptoms secondary to a pontine cavernoma. Alongside the clinical details, we
review similar cases reported in the literature, including presentations such as trigeminal neuralgia and other
cranial nerve syndromes arising from pontine lesions. The report outlines the surgical approach, intraoperative
techniques, and postoperative management in detail. Advanced neuromonitoring and careful selection of safe
entry zones were critical to the operative plan. The patient experienced a favorable recovery, with improvements
noted during rehabilitation and on follow-up imaging. In discussing this case, we highlight the balance between
achieving maximal safe resection, often subtotal in brainstem surgery, and minimizing the risk of rehemorrhage
while preserving neurological function.