Radiosurgery for Symptomatic Cavernous Malformation in the Brainstem: Two Difficult Cases with Large and Multiple Lesions

It is well known that cavernous malformations become much more hemorrhagic after the initial hemorrhage and that brainstem lesions are more dangerous than the lesions in the supratentorial location. It is very difficult to handle symptomatic cavernous malformations associated with repetitive hemorrhages in the brainstem. Patients may be suffering from brainstem syndromes such as hemiparesis, hemisensory disturbance, ataxia, and disturbed ocular movement. We have encountered two such difficult cases, one is very large and the other is multiple and familiar, accompanying repetitive brainstem hemorrhages. Since microsurgery seems to be very difficult and hazardous, these two cases were treated with radiosurgery after several hemorrhages.