Intraoperative rupture of brainstem cavernous malformation

Although cavernous malformations (CMs) are an important cause of intracranial hemorrhage, the natural history of these lesions is controversial. Both retrospective and prospective studies undertaken to define risk factors for hemorrhage from CMs have consistently identified the location of a lesion as a factor that has a significant impact on the rate of rupture, and brainstem CMs consistently have a higher rate of symptomatic hemorrhage than those at other locations. The mechanism underlying this disparity in rupture rates, however, remains obscure. Most authors attribute the difference, at least partially, to the sensitivity of the brainstem to hemorrhage. Regardless, the specific factors that cause a given CM to rupture are unknown. The authors report their first encounter with an intraoperative rupture of a CM in the brainstem. This case underscores the risks encountered during the surgical approach to brainstem CMs and may provide insight into the pathophysiological mechanisms underlying the rupture of these lesions.