PMC10316179_01
PMC10316179_02
The magnetic resonance imaging on the first admission. The classic popcorn cavernoma (blue arrow) is seen in the right pontomedullary region of the brainstem in the sagittal (a) and coronal views (b). (c) The lymphangioma is seen in the left supraclavicular and neck region (orange arrow).
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F1
A head and neck computed tomography scan and magnetic resonance imaging (MRI) [Figure 1] on admission revealed a brainstem hemorrhage and a giant suprascapular and mediastinal lymphangiomatous malformation.
Brain magnetic resonance imaging on the second admission. (a) Sagittal cut showing a 27 x 28 x 26 mm pontomedullary cavernoma (blue arrow) and hydrocephalus (green arrow). (b) Axial cut showing the heterogeneous lesion with a hemosiderin ring and severe compression of the brain stem (blue arrow). (c) Coronal cut showing hydrocephalus (green arrow) and significant regression of the lymphangioma (blue arrow) compared to magnetic resonance imaging on first admission.
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F2
Intraoperative images. (a) The exposure of the telovelor membrane and the bulging medulla oblongata with hemosiderin discoloration (white arrow). The cerebellar tonsils (blue arrows). (b) The opened cavernoma with the preserved developmental venous anomaly (DVA) (blue arrow). Cerebellar vermis (black star).
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F3
The dorsal surface of the upper medulla oblongata was seen bulging and hemosiderin-stained [Figure 3a]. A small incision was made at the most presenting surface of the cavernoma, and the hematoma was evacuated and sent for histology [Figure 3b].
The 4 months postoperative magnetic resonance imaging. Blue arrow-resolving postoperative changes in the brainstem.
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F4
The 4 months postoperative MRI showed normal resolving postoperative changes [Figure 4].