Guilherme H. W. Ceccato,1 Rodolfo F. M. da Rocha,2 Julia Goginski,2 Pedro H. A. da Silva,2 Gabriel S. de Fraga,3 Marcio S. Rassi, MD,4 and Luis A. B. Borba, MD, PhD, IFAANS4,5

1School of Medicine, Federal University of Paraná, Curitiba, PR, Brazil; 2School of Medicine, Faculdade Evangélica do Paraná, Curitiba, PR, Brazil; 3School of Medicine, Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; 4Department of Neurosurgery, Evangelic University Hospital of Curitiba, PR, Brazil; 5Department of Neurosurgery, Federal University of Paraná,
Curitiba, PR, Brazil


Abstract
Brainstem cavernous malformations are especially difficult to treat because of their deep location and intimate relation with eloquent structures. This is the case of a 26-year-old female presenting with dizziness, dysmetria, nystagmus and unbalance. Imaging depicted a lesion highly suggestive of a cavernous malformation in the left inferior cerebellar peduncle. Following a suboccipital midline craniotomy, the cerebellomedullary fissure was dissected and the lesion was identified bulging the surface. The malformation was completely removed with constant intraoperative neurophysiological monitoring. The patient presented improvement of initial symptoms with no new deficits. Surgical resection of brainstem cavernous malformations can be successfully performed, especially when superficial, using the inferior cerebellar peduncle as an entry zone.


**Intro music: "Daybreak" by Graeme Rosner

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