Symptomatic pontine cavernous malformation, associated with venous anomaly. Symptoms abated for a number of years, then the lesion grew with new gaze symptoms in 2010. The cavernoma was exophytic at the fourth ventricular floor and was resected via a posterior fossa trans-vermian exposure.. There are postoperative findings related to suboccipital craniotomy and trans-vermian approach for resection of a posterior pontine cavernous malformation, where there is a crescentic area of susceptibility effect that measures up to 8 mm in length. There are multiple other punctate foci of susceptibility effect in the pons and midbrain. There is also a left pons developmental venous anomaly. There is diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is also nonspecific patchy T2 hyperintensity in the medulla. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nodule lesion in the left nasal bridge subcutaneous tissues that measures up to 12 mm and which likely represents an inclusion cyst. There is bilateral maxillary sinus mucosal thickening with fluid on the right side.
1. Postoperative findings related to resection of a posterior pontine cavernous malformation with an associated left pons developmental venous anomaly. Areas of susceptibility effect along the margin of the surgical bed may represent postoperative hemorrhage versus residual hemosiderin that comprised the periphery of the cavernous malformation. More precise characterization is otherwise limited without available preoperative imaging.2. Punctate areas of susceptibility effect in the pons and midbrain beyond the surgical bed may represent microhemorrhages or additional cavernous malformations.3. Findings suggestive of acute sinusitis.