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. 2024 Jul 29;8(5):CASE2456.
doi: 10.3171/CASE2456. Print 2024 Jul 29.

Cervicomedullary cavernous malformation of the C1 nerve root: illustrative case

Yi Zhang  1 , Lorenzo Yuan  1 , Neelan J Marianayagam  1 , Kevin K Kumar  1 , Parastou Fatemi  1   2 , David J Park  1 , Steven D Chang  1
Affiliations

Cervicomedullary cavernous malformation of the C1 nerve root: illustrative case

Yi Zhang et al. J Neurosurg Case Lessons. .

Abstract

Background: Cavernous malformations (CMs) originating from spinal nerve roots are rare but can present with rapidly progressing neurological deficits. Therefore, quick identification and treatment are essential.

Observations: The authors present the case of a 52-year-old male presenting with headaches and gait disturbance, found to have a CM of the C1 nerve root. The patient underwent successful suboccipital craniectomy and C1 laminectomy, with complete resection of the lesion, preservation of the cervical spinal nerve roots, and symptomatic improvement postoperatively.

Lessons: This is the first presentation in the literature of a CM originating from the C1 nerve root. The authors show complete resection of the lesion with preservation of the C1 nerve root. Nerve root lesions usually show insidious symptomatic onset. Quick identification and resection are recommended to prevent permanent neurological disability. https://thejns.org/doi/10.3171/CASE2456.

Keywords: arteriovenous malformation; cavernous malformation; surgery.

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Figures

FIG. 1.
FIG. 1.
Imaging findings. A: Sagittal T1 image demonstrating an approximately 1.5-cm T1-hyperintense globular lesion at the level of the foramen magnum. B: Sagittal T1 postcontrast sequence demonstrating homogeneous contrast enhancement of the lesion. C: The lesion was also T2 hyperintense. D: GRE revealed a peripheral GRE-positive margin. E and F: Axial GRE images showing multiple other GRE-positive intraparenchymal lesions scattered throughout the supratentorial and infratentorial compartments.
FIG. 2.
FIG. 2.
Intraoperative view showing the origin of the lesion.
FIG. 3.
FIG. 3.
Pathology findings: clots, blood products, and thin-wall blood vessels of various diameters associated with hemosiderin-laden macrophages, consistent with a diagnosis of CM. Hematoxylin and eosin staining, original magnification ×4.
See this image and copyright information in PMC

References

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