| Summary: | An 8-year-old boy presented with progressive left-sided weakness due to a large thalamic cavernous malformation (CM) that did not have a developmental venous anomaly. It was resected under evoked potentials monitoring. The operation was uneventful until, for no identifiable reason, the motor evoked potentials were lost towards the end of the resection. Four years later, the motor function in his hand was worse but his leg strength was better than before surgery. His sensory exam was normal. An MRI at 4 years post operation showed complete resection without a definite substrate for the increase in his hand weakness. The child had adapted well to his deficit, was happy and developing normally in all spheres.This case, along with the other 10 reported worldwide, suggests that the outcome of surgical resection, even if a new limited motor deficit ensues, is better than the natural history of the disease. We also discuss the operative decision making after the loss of the motor evoked potentials.
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