Objective: To evaluate the treatment of movement disorders which presented as a consequence of haemorrhage from midbrain cavernous malformations.

Background: Few cases of movement disorders which presented as a consequence of haemorrhage from cavernous malformations of the brainstem were reported in the literature. We present two patients with a haemorrhage from midbrain cavernous malformations which were treated by surgical resection. Both patients developed movement disorders about a month after surgery and were successfully treated with medications.

Methods: Patient T. suffered a haemorrhage from tectal cavernous malformation and presented with occlusive hydrocephalus (GCS 12 an admission). Ventriculo-peritoneal shunting was performed and cavernoma was removed via supracerebellar infratentorial approach in the subacute phase of the haemorrhage. 23 days after surgery patient developed hemidystonia and parkinsonism symptoms. Patient H. had a haemorrhage from cavernous malformation of right cerebral peduncle. He presented with left-sided hemiplegia and right-sided oculomotor palsy. Cavernoma was removed completely via right pterional transsylvian approach , . He was discharged with the regression of hemiparesis (3/5). 34 days after surgery patient developed tremor in left upper extremity (Holmes tremor).

Results: Patient T. (follow-up 4 years) was treated with pramipexole, levodopa, amantadine, clonazepam and levitiracetam. Currently he is symptom-free and receives amantadine 50 mg/day, clonazepame 0.375 mg/day and levitiracetam 500 mg/day. Patient H. (follow-up 3.5 years) received levodopa treatment and his tremor is currently improved more than 50% from the baseline.

Conclusions: Our long-term follow-up on conservative treatment of this rare entity (development of movement disorders after surgical treatment of midbrain cavernous malformations) confirms that it is highly effective.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/successful-treatment-of-movement-disorders-after-resection-of-midbrain-cavernous-malformations-report-of-two-cases/