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We report the case of a 66-year-old lady who came to us with a complaint of severe giddiness persisting for a period of 3 months. She had consulted a cardiologist for hypertension and the cardiac evaluation was negative. A brain scan subsequently revealed a mass of blood vessels compressing the deepest aspect of the left side of the brain and reported as cavernoma.
She has advised of surgery in view of the natural propensity of the tumor for bleeding. Bleeding in the area of the brain called pons- a thumb size structure in the deep cavity of the brain that controls our consciousness, breathing, and movement of the eye can be devastating and can lead to respiratory arrest and even death.
The patient was referred in a timely manner by Dr. Ranganathan, consultant cardiologist to Dr. Amitendu Sekhar, the consultant neurosurgeon. The patient and son as well as close relatives were informed about the definitive procedure to excise the lesion that gave the best chance to prevent future bleeding. The risks of such a complex procedure included bleeding, incomplete excision, intraoperative death as well as permanent disability such as stroke, weakness, and respiratory dysfunction. These potential risks were explained to the relatives and the patient. This patient had also consulted many reputed hospitals in Chennai and Bangalore and had received the same information about the above risks and ultimately confidently chose Manipal Salem and Dr.Amitendu Sekhar.
The patient was taken in for surgery under general anesthesia, after making a small 3cm hole in the skull behind the left ear with the help of a microscope and an endoscope. Dr. Amitendu Sekhar successfully excised the lesion. The patient was kept under observation in the ICU for the next 24 hours and subsequently sent to the ward. She was then started on oral feeds and discharged after 3 days. She is currently in the process of follow-up consultations and her giddiness has subsided completely.
Remarks-
Pontine cavernoma is a rare disorder among blood vessel tumors that has a propensity for bleeding.
The tumor may have been present since birth and in many cases may cause unconsciousness due to bleeding due to which, many a times the patient cannot be saved. We report having managed the case successfully due to the presence of an experienced team of doctors as well as tertiary care infrastructure.
Dr. A. Sekhar, MBBS., DNB (Neurosurgery),
Fellow Micro Neuro Surgery – Japan
Fellow Neuro Surgery NNI – Singapore
Member CNS (USA) Member EANS
Consultant & HOD Neurosurgery
Amit.sekhar@manipalhospitals.com
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