Abstract
BACKGROUND: Various brainstem pathologies cause hiccups. CASE DESCRIPTION: A 45-year-old man with cerebral cavernous malformation (CCM) in the pons, identified at the age of 25 years, experienced an exacerbation of left hemiparesis. The patient presented with left oculomotor and facial nerve paresis, trigeminal pain, and swallowing disturbances, though hiccups were not observed. Cerebral magnetic resonance imaging revealed a hemorrhagic mass occupying the dorsal pons, predominantly on the right side, along with multiple hemosiderin deposits in the cerebral and cerebellar hemispheres. The patient underwent a microsurgical CCM resection. Intraoperatively, traction maneuvers on the CCM, which severely adhered to the right lower pons, reproducibly caused intense hiccups. The hiccups resolved within minutes of the release of traction. Genomic analysis of CCM identified CCM1 mutation. Postoperatively, the patient had no recurrence of hiccups. CONCLUSION: Surgical resection of large pontine CCMs can cause intraoperative hiccups, potentially hindering the continuation of surgery. Despite common genomic mutations, multiple CCMs may exhibit diverse biological behaviors.