Foville Syndrome Due to Pontine Hemorrhage and Pontine Infarct: Case Series

Foville Syndrome is a rare clinical feature of stroke or brain hemorrhage. Few cases have been reported worldwide particularly in Asian, Indonesia, Aceh. Patient 1: We report the case of a female 64 years old patient, was admitted in the Neurology Department of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, for an abrupt onset of right body side weakness two day before admission. That weakness was preceded by acute headaches and rotatory vertigo with vomiting. with hypertension history since 5 years. Physical examination found paralysis of right oculomotor movements with intact response of pupils to light, right trochlear nerve palsy, left ipsilateral facial nerve palsy, and right hemiparesis which constitute of Foville syndrome. The brain CT scan shown in the right pontine hypodensity area is pontine infarct. Etiological investigations done to chronic hypertension. Patient received antiplatelet therapy and control of vascular risk factors for secondary prevention (hypertension theraphy), and physiotherapy as treatment with clinical improvement. And she has been discharge 8 days later. Patient 2: 45-year-old right-handed female, was admitted in the Neurology Department of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, for an abrupt onset of right body side weakness two day before admission. That weakness was preceded by acute headaches and rotatory vertigo with vomiting. with hypertension history since 5 years. Physical examination found paralysis of right oculomotor movements with intact response of pupils to light, right trochlear nerve palsy, left ipsilateral facial nerve palsy, and right hemiparesis which constitute of Foville syndrome. The brain CT scan shown spontaneous hemorrhage in the left pontine’s. Etiological investigations done to chronic hypertension. Patient received therapy control of vascular risk factors for secondary prevention (hypertension theraphy), and physiotherapy as treatment with clinical improvement. And she has been discharge 10 days later. The diagnosis and management of brainstem stroke bring a considerable burden to the healthcare system, the patient, the family members, and the society at large. The slow increase in the global burden of stroke has been steadily increasing.

Supracerebellar Infratentorial Infratrochlear Trans-Quadrangular Lobule Approach to Pontine Cavernous Malformations

BACKGROUND Brainstem cavernous malformations with symptomatic hemorrhage have a poor natural history. Those without a pial or ependymal presentation are often observed given the morbidity of resection. Surgical removal is considered only in patients with accessible lesions that have repeated symptomatic hemorrhagic. OBJECTIVE To describe a novel supracerebellar infratentorial infratrochlear trans-quadrangular lobule approach to safely resect lesions in the upper pons. METHODS We use a hybrid paramedian/lateral suboccipital craniotomy in the gravity-dependent supine position. Opening the cerebellomesencephalic fissure over the tentorial surface of the cerebellum brings the trochlear nerve, branches of the superior cerebellar artery, and the quadrangular lobule of the cerebellum into view. Removal of small a portion of the quadrangular lobule defines an entry point on the superomedial aspect of the middle cerebellar peduncle, and a surgical trajectory aimed superior to inferior. RESULTS A total of 6 patients underwent this approach. All presented with symptomatic hemorrhage and all cavernous malformations were completely resected. Five patients were improved or unchanged with modified Rankin scale scores of 1 or 2. CONCLUSION The trans-quadrangular lobule approach allows safe resection of upper pontine cavernous malformations along a superior to inferior trajectory.