Child's Brain 5 : 131-136(1979) Successful Surgical Treatment of Pontine Vascular Malformation in a 3-Year Old Case Report Narayan Sundaresan, Joseph Galicich, George Krol and Gerald Rosen Department of Neurosurgery and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, N.Y. Key Words. Vascular malformation • Pons • Surgical treatment Abstract. A 3-year-old male presented with progressive right hemiparesis. Clinical and radiological studies suggested the diagnosis of brain stem glioma. At surgery, a small vascular malformation of the pons was encountered. Although rare, vascular malforma­ tions must be considered in the differential diagnosis of brain stem masses. Introduction Vascular malformations of the pons are rare and most of them remain asymptomatic during life [2. 25]. These lesions are regarded as hamartomas rather than true neoplasms although there has been a single case report of an intrapontine hemangioblastoma [20], McCormick [18] has suggested that small lesions under 3 cm in diameter should be regarded as ‘cryptic’ mal­ formations. Cryptic malformations tend to be equally common in the supra­ tentorial and infratentorial compartments; in several autopsy series [18, 27], the pons is the single most common site of telangiectases. Most spontaneous intrapontine hematomas are presumed to be due to small vascular malforma­ tions especially in young patients without systemic disease. We wish to record successful surgical treatment in a 3-year-old child presenting with symptoms suggesting a pontine tumor. Case Report Downloaded by: HSC Library-Serials Dept., SUNY 129.49.5.35 - 1/20/2020 3:15:50 AM The patient was a 3-year-old Hispanic male who was admitted to Memorial SloanKettering Cancer Center with a 2-month history of progressive weakness on the right side. Sundaresan/Galicich/Krol/Rosen 132 His mother had noted that the child first developed a limp in his right leg. This leg became progressively weaker so that he began crawling upstairs instead of being able to walk normally. This was followed by weakness of the right arm manifest by increasing use of his left hand in reaching for objects although he was ordinarily right-handed. The child also complained of some nonspecific occipital headaches. I lis past history was unremarkable. The child had been born at term by cesarean section and developmental milestones were normal till the present. Neurological examination showed a well-developed child who walked with a broadbased gait and an added limp on the right side. His speech appeared appropriate for his age. Cranial nerve examination showed full extraocular movements with no papilledema. There w