1. Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

4. Medical School Foundation Core Training Specialist Training 1823252733y Medical School ResidencyUndergrad

5. Overview Case presentation Operative approaches Management of cavernomas

6. Case presentation 13yo Asian male, previously well Presents with: new sudden-onset global headache left UE and LE “tingling” malaise No significant PMH, non-contributory FH, school student, lives with parents Neuro: intact except subjective L hemisensory abnormality

7. Emergent Head CT

8. MR No enhancement or feeding/draining vessels

11. Ozek & Ture. Childs Nerv Syst. 2002.

12. Benign vascular lesion and clot Consistent with cavernous malformation POD7 - Mild LUE drift, resolved parasthesiae

13. Al-Holou et al. J Neurosurg Pediatr. 2012.

14. Cortes Vela et al. Radiology. 2012

15. Cavernous malformation AsymptomaticSymptomatic Observe Non-resectableResectable Neurological Seizures Haemorrhage { Lifetime Risk = 1- (1-P)^Y Resection risk 5% Al-Holou et al. J Neurosurg Pediatr. 2012.

16. Jay et al. Br J Neurosurg. 2012; Amin-Hajani. Neurosurgery. 1998. 16 symptomatic CAs - 15-55 y.o. - 13.31Gy 3.59% annual haemorrhage rate post-gamma knife cf 8% in Michigan case series Harvard proton beam sig morbidity at 5y

17. Thanks Drs Sack & Levy