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Moran NF, Fish DR, Kitchen N, Shorvon S, Kendall BE, Stevens JM. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry 1999; 66:561-8. [PMID: 10209164 PMCID: PMC1736368 DOI: 10.1136/jnnp.66.5.561] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To characterise the clinical features and response to treatment of supratentorial cavernomas associated with epilepsy. METHODS A systematic review of the literature was carried out and a retrospective case series of patients with cavernoma diagnosed by MRI and/or histology was compiled. Patient selection biases in the literature review were reduced as far as possible by selection of unbiased publications. RESULTS In the literature, cavernomas were relatively less common in the frontal lobes. There were multiple cavernomas in 23% of cases. The main clinical manifestations were seizures (79%) and haemorrhage (16%). The annual haemorrhage rate was 0.7%. The outcome after excision was good with improvement in seizures in 92% of patients. In the case series the surgical outcome was less favourable, reflecting inclusion of a higher proportion of patients with intractable epilepsy. In both the literature review and the case series, outcome was poorer in cases with a longer duration of seizures at the time of surgery. CONCLUSIONS The good surgical results, particularly in cases treated earlier, and the significant cumulative haemorrhage rate, suggest that excision is the optimum treatment. However, these factors have not been examined prospectively and, despite the availability of several retrospective studies, the optimum treatment, particularly for non-intractable cases, will only be determined by a prospective study.
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Affiliation(s)
- N F Moran
- The Epilepsy Research Group, The Institute of Neurology, 33 Queen Square, London,UK.
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52
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Reyns N, Assaker R, Louis E, Lejeune JP. Intraventricular cavernomas: three cases and review of the literature. Neurosurgery 1999; 44:648-54; discussion 654-5. [PMID: 10069603 DOI: 10.1097/00006123-199903000-00119] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Cavernomas occur very rarely in the ventricular system. We report three cases of intraventricular cavernomas and review the literature. CLINICAL PRESENTATION A 16-year-old female patient presented with a sudden distal deficit of the left superior limb. She had a voluminous tumor involving the two lateral ventricles, with radiological evidence of recent hemorrhage. A 30-year-old man presented with generalized seizures and a right hemiplegia related to a 4-cm-diameter cavernoma in the two lateral ventricles involving the interhemispheric scissure through the corpus callosum and left centrum ovale. The radiological appearance was not typical and did not allow the diagnosis. A 42-year-old man had a cavernoma in the third ventricle, which was responsible for his short-term memory loss. This cavernoma had been revealed by computed tomography that was performed after intracerebral hemorrhage related to another cavernoma in the right parietal lobe occurred. INTERVENTION Stereotactic biopsies allowed the diagnosis of intraventricular cavernoma in the first case. Surgical removal via a right transcortical transventricular approach and a transcallosal approach in the first and second cases, respectively, was complete, resulting in good outcomes. Surgical removal via a right transcortical transventricular approach in the third case was partial. CONCLUSION Intraventricular cavernomas are so uncommon that only 42 well-documented cases have been previously reported in the literature. It seems that their radiological diagnosis may be difficult because of their uncommon location in the ventricular system and their voluminous size. A wrong preoperative diagnosis has sometimes been the cause of inefficient therapy, such as radiotherapy, for these surgically curable benign lesions.
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Affiliation(s)
- N Reyns
- Department of Neurosurgery, University of Lille, France
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53
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Voelker JL, Stewart DH, Schochet SS. Giant intracranial and extracranial cavernous malformation. Case report. J Neurosurg 1998; 89:465-9. [PMID: 9724123 DOI: 10.3171/jns.1998.89.3.0465] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Massive enlargement of an extracerebral cavernous malformation and extension across tissue planes is very uncommon. The authors present the case of a 49-year-old woman with a giant cavernous malformation in the left frontotemporal area. It progressively enlarged during several decades, extended through the calvaria to the extradural space, and was surgically treated. The lesion may have originated in the soft tissue or the skull. The locations of cavernous malformations in various parts of the body are reviewed and their mechanisms of growth are discussed. Surgical excision is the treatment of choice.
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Affiliation(s)
- J L Voelker
- Department of Pathology, West Virginia University School of Medicine, Morgantown, USA.
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54
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Greiner-Perth R, Neubauer U, Schenke H. Chronic encapsulated intracerebral hematoma--a well-defined disease. Report on two cases and review of the literature. Neurosurg Rev 1998; 20:231-8. [PMID: 9457717 DOI: 10.1007/bf01105893] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic encapsulated intracerebral hematoma (CEIH) is a rare disease which is believed to be caused by angiographically negative vascular malformations. CEIH has the following characteristic findings: 1. It affects all age groups 2. Clinical symptoms progress slowly after sudden onset. Often there is a latency of months or years 3. There is no correlation with arterial hypertension 4. Imaging reveals a typical fibrous capsule with enclosed blood contents and signs of recurrent bleedings 5. Cavernoma was identified histologically as the cause of bleeding in 30% of cases. 6. All patients had a primary diagnosis of intracerebral tumor. To the best of our knowledge, 27 cases have been reported in the literature. We now add two cases, one of which is the first in the available literature which was not operated and could be followed by imaging.
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Affiliation(s)
- R Greiner-Perth
- Department of Neurosurgery, Zentralklinik Bad Berka GmbH, Federal Republik of Germany
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55
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Duffau H, Capelle L, Sichez JP, Faillot T, Bitar A, Arthuis F, Van Effenterre R, Fohanno D. Early radiologically proven rebleeding from intracranial cavernous angiomas: report of 6 cases and review of the literature. Acta Neurochir (Wien) 1997; 139:914-22. [PMID: 9401650 DOI: 10.1007/bf01411299] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although intracranial cavernomas are known to cause haemorrhage, data concerning the frequency, severity and delay of recurrent bleedings are controversial. We report a series of 6 patients with histologically proven cavernoma, presenting with early clinical signs and radiological proof of rebleeding, that is occurring in the first month after initial overt haemorrhage. These 6 cases have been selected from a series of 142 patients seen between 1980 and 1995 in our department with cavernous angiomas or so-called AOVMs, of whom 93 presented with clinical symptoms of haemorrhage (34 patients presented symptoms of one or more rebleeding, but only 6 had radiological proof). All patients suffered neurological worsening due to the rebleeding, with an increase of the size of the haematoma on the CT scan. Five MRIs were performed at the acute stage: 3 showed evidence of cavernoma (60%). All patients underwent surgery at the acute stage of the rebleeding, with 5 improvements and 1 stabilization. A cavernous angioma was found in 5 cases at first surgery, but a further operation was necessary in the last patient to find and remove the cavernoma, after a second rebleeding following the first intervention. Our series reveals a high frequency of rebleeding after a first intracranial haemorrhage from a cavernous angioma, and highlights the precocity of such rebleedings. Therefore, we advocate early aggressive surgical management: in cases of cavernoma revealed by a first clinical overt haemorrhage, when there is strong radiological suspicion at the acute stage; and in all cases of rebleeding, even without radiological evidence of malformation, in the absence of vascular risk factors. Surgical indication must be discussed in particular cases of cavernomas of the brain stem when neither the haematoma nor the cavernoma reach the surface, and in deep supratentorial cavernomas, when the neurological status is good, because of the therapeutic risk.
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Affiliation(s)
- H Duffau
- Department of Neurosurgery 1, Hôpital de la Salpêtrière, Paris, France
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56
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Vaquero J, de Prado F, Pedrosa M, Parajón A. Epilepsía asociada a cavernomas: Resultado quirúrgico a largo plazo. Neurocirugia (Astur) 1997. [DOI: 10.1016/s1130-1473(97)71038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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57
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Di Rocco C, Iannelli A, Tamburrini G. Cavernomas of the central nervous system in children. A report of 22 cases. Acta Neurochir (Wien) 1996; 138:1267-74; discussion 1273-4. [PMID: 8980728 DOI: 10.1007/bf01411054] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A series of 22 patients under the age of 15 years with cavernomas were treated at the Section of Paediatric Neurosurgery of the Catholic University of Rome between 1981 and 1995. The most common symptoms at presentation were epilepsy, in 12 children, and intracranial hypertension, in 9 children; seizures were present on admission in 14 patients; no patient had a family history of cerebro-vascular malformations, two had multiple lesions. Radiological signs of significant acute and subacute haemorrhage were found in 17 cases. The supratentorial compartment was the most frequent location of the lesions, with only three subtentorial cavernomas. The post-surgical results were good: only four children had a persistence of pre-surgical neurological signs, even though they were ameliorated by the treatment. No patient showed a progression of pre-operative neurological signs, nor the onset of new deficits. Only one child died, but his clinical condition was critical before surgery, because of deep coma, with bilaterally dilated and fixed pupils, and no response to any stimulation. Our results suggest that the younger children present significant haemorrhage more frequently than the older ones; this is demonstrated by the analysis of the mean age of the patients with macro-haemorrhage (= 7 years) and the average age of those without macro-haemorrhage (= 11 years). The removal of cavernomas was always able to control the seizure disorders of our patients, proving that in these cases lesionectomy alone may be sufficient to resolve epilepsy.
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Affiliation(s)
- C Di Rocco
- Department of Neurosurgery, Catholic University Medical School, Rome, Italy
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58
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Fujii M, Arisawa M, Morimoto M, Kurisaka M, Mori K. Supra- and infratentorial multiple cavernous angiomas in an infant: report with MR evaluation of an unusual case. Childs Nerv Syst 1996; 12:564-7. [PMID: 8906376 DOI: 10.1007/bf00261614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A rare case of multiple cavernous angiomas with repeated hemorrhages in a 9-month-old male infant is presented, together with sequential computed tomography (CT) and magnetic resonance (MR) images. The infant underwent hematoma evacuation for left cerebellar hemorrhage and his postoperative course was uneventful. The multiple cavernous angiomas receded gradually without any treatment except the hematoma evacuation. Two years following presentation, he continues to do well. To the authors' knowledge, this is the first report of multiple cavernous angiomas with brain stem involvement in an infant.
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Affiliation(s)
- M Fujii
- Department of Neurosurgery, Kochi Medical School, Japan
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59
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Passarin MG, Salviati A, Gambina G, Tezzon F, Tomelleri G, Deotto L, Zanoni T, Bovi P, Gerosa M, Nicolato A, Mazza C, Iuzzolino P, Ghimenton C, Ferrari G. Familial cavernous hemangioma with atypical neuroimaging. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1996; 17:295-300. [PMID: 8915762 DOI: 10.1007/bf01997790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Three members of the same family were studied, all of whom had multiple intracerebral cavernous angiomas for which a dominant autosomal inheritance was hypothesised. The proband suffered from headaches, and physical examination revealed evident right hemiparesis. The second case started with a hemorrhagic cerebral stroke and the third was asymptomatic on neurological examination. Nuclear magnetic resonance (NMR), performed in two of the three cases, showed lesions whose number and extent were not radiologically characteristic of cavernous angioma. A cerebral biopsy of the proband enabled the diagnosis to be made. Despite the recent introduction of NMR, the nosological classification of familial forms can be difficult when the radiological lesions are atypical. In such cases, cerebral biopsy is not only a valid diagnostic aid, but is also indispensable for obtaining adequate genetic information.
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Affiliation(s)
- M G Passarin
- Divisione di Neurologia, Ospedale Maggiore, Università di Verona, Italy
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60
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Zevgaridis D, van Velthoven V, Ebeling U, Reulen HJ. Seizure control following surgery in supratentorial cavernous malformations: a retrospective study in 77 patients. Acta Neurochir (Wien) 1996; 138:672-7. [PMID: 8836281 DOI: 10.1007/bf01411470] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Of 168 patients operated on consecutively for a supratentorial cavernous malformation, 77 had seizures as the initial symptom. The effectiveness of surgery in controlling seizures and the risk of surgery were evaluated by retrospective review of the patients' charts. The follow-up period was 1 to 9 years (mean 39 months) and the review period totalled 284 lesion-years. Only two patients showed postoperative deterioration in neurological status (morbidity risk: 2.6%), no patient died (mortality: 0%). Sixty-eight (88.3%) patients were seizure-free after operation and five (6.5%) showed a marked reduction in the frequency of their seizures. This corresponds to an overall positive effect of surgery of 94.8% of the patients. There was no substantial evidence that excision of the haemosiderin-stained tissue around the cavernoma along with the lesion itself provided better results than resection of only the cavernoma. Better results with regard to seizure control, however, were associated with shorter duration of symptoms before surgery.
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Affiliation(s)
- D Zevgaridis
- Department of Neurosurgery, University Clinic of Munich, Federal Republic of Germany
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61
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62
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Maraire JN, Awad IA. Intracranial cavernous malformations: lesion behavior and management strategies. Neurosurgery 1995; 37:591-605. [PMID: 8559286 DOI: 10.1227/00006123-199510000-00001] [Citation(s) in RCA: 210] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Intracranial cavernous malformations are vascular anomalies consisting of endothelium-lined caverns filled with blood at various stages of thrombosis and organization and separated by a collagenous stroma devoid of mature vessel wall elements. They occur in an estimated 0.45 to 0.9% of the population, with male and female patients equally affected and all ages represented. They commonly manifest as seizures, gross intracranial hemorrhage, and focal neurological deficits. Lesions are frequently multiple in the same patient, and 10 to 30% are associated with familial clustering. Several reports have documented a dynamic clinical-radiological lesion behavior with de novo lesion genesis, intralesional and perilesional hemorrhage, and corresponding fluctuations in lesion size. Hemorrhagic risk and neurological disability seem to be related to multiple factors, including lesion location, age, gender, state of reproductive cycle, and previous hemorrhage. Lesions may behave aggressively with repetitive hemorrhages and cumulative disability or may remain quiescent for many years. Management strategies include expectant follow-up in patients with asymptomatic or inaccessible lesions, excision of symptomatic and accessible lesions, and radiosurgery of progressively symptomatic lesions in inoperable locations. Relevant disease-specific outcome parameters are proposed to guide clinical decisions and future research. Prospective, stratified, hypothesis-driven studies using rigorous epidemiological methods must be undertaken to delineate patient and lesion factors influencing clinical aggressiveness. Biological studies are essential to uncover strategies to predict and modify lesion behavior.
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Affiliation(s)
- J N Maraire
- Neurovascular Surgery Program, Yale University School of Medicine, New Haven, Connecticut, USA
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63
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Harrison MJ, Eisenberg MB, Ullman JS, Oppenheim JS, Camins MB, Post KD. Symptomatic cavernous malformations affecting the spine and spinal cord. Neurosurgery 1995; 37:195-204; discussion 204-5. [PMID: 7477769 DOI: 10.1227/00006123-199508000-00002] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ten cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrospectively reviewed. The cases display a spectrum of pathological findings involving the vertebral body, vertebral body with epidural extension, epidural space without bony involvement, intradural extramedullary space, and intramedullary lesions. Lesions at all locations are identical histologically, electron microscopically, and immunohistochemically. This perspective, in which cavernous malformations are envisioned as a single entity arising at numerous locations, runs contrary to the view found in the neurosurgical literature. In most discussions of cavernous malformations, vertebral body lesions are depicted as separate entities from intradural lesions. Cavernous malformations, also called cavernous hemangiomas, are developmental vascular hamartomas that, by definition, do not grow by mitotic activity. Yet, the expansion of these lesions is well documented both in the literature and among our cases. The therapeutic modalities used in our series included observation, embolization, radiation, and surgical resection alone or in combination. All modalities are effective but must be tailored to the specific needs and condition of the patient. The embryology, methods of treatment, and proposed mechanisms of growth, plus similarities and differences between cavernous malformations at each location, are reviewed. Analogies between spinal and intracranial lesions are presented. On the basis of this series and a review of the literature, we conclude that cavernous malformations represent a single entity regardless of location. Segregation based on location, as is prevalent throughout the neurosurgical literature, hinders an overall understanding of these lesions. Cavernous malformations are more appropriately viewed as a single pathological entity arising in a multitude of locations. The difficulties encountered when managing cavernous malformations at various locations are unique to the location and not the lesion.
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Affiliation(s)
- M J Harrison
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
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64
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Loesch DV, Gilman S, Del Dotto J, Rosenblum ML. Cavernous malformation of the mammillary bodies: neuropsychological implications. Case report. J Neurosurg 1995; 83:354-8. [PMID: 7616285 DOI: 10.3171/jns.1995.83.2.0354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors present the first documented case of a cavernous malformation of the mammillary bodies. A 34-year-old woman presented with a 2-month history of headaches and acute memory changes. Magnetic resonance imaging studies demonstrated a retrochiasmatic interpeduncular lesion that was initially thought to be a craniopharyngioma. Operative resection confirmed the diagnosis of a cavernous malformation. This particular case is unique in its destruction of the mammillary bodies and presents further evidence of the relationship of these regions to memory. This report is also the first to document results of pre- and postoperative neuropsychological evaluations that specifically address the memory deficits created by destruction of the mammillary bodies.
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Affiliation(s)
- D V Loesch
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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65
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66
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67
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Sinson G, Zager EL, Grossman RI, Gennarelli TA, Flamm ES. Cavernous malformations of the third ventricle. Neurosurgery 1995; 37:37-42. [PMID: 8587688 DOI: 10.1227/00006123-199507000-00005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CAVERNOUS MALFORMATIONS ARE uncommon lesions that are usually present in the cerebral hemispheres. Less frequently, these malformations are seen in the brain stem, basal ganglia, or paraventricular regions. We report four cases of cavernous malformations of the third ventricle. Patients presented with symptoms of hydrocephalus, memory loss, and signs of hypothalamic dysfunction. Magnetic resonance imaging and computed tomography provided characteristic images of the three lesions preoperatively. All patients underwent direct surgical excision of the malformations. Two patients had a transcallosal, transventricular approach, the third underwent a transcortical, transventricular approach, and the fourth had an infratentorial supracerebellar approach. Postoperatively, the patient with hypothalamic dysfunction has not improved and underwent ventriculoperitoneal shunting. The second patient did well initially; however, 8 days postoperatively, she became comatose and later died. The presumed cause of her deterioration was a hypothalamic venous infarction. The third and fourth patients have returned to their normal neurological baseline. The presenting signs and symptoms, magnetic resonance imaging and computed tomography findings, and treatment options for this rare lesion are discussed and illustrated.
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Affiliation(s)
- G Sinson
- Division of Neurosurgery, Hospital of University of Pennsylvania, Philadelphia, USA
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68
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Casey AT, Thomas DG, Harkness WF. Stereotactically-guided craniotomy for cavernous angiomas presenting wit epilepsy. Acta Neurochir (Wien) 1995; 137:34-7. [PMID: 8748865 DOI: 10.1007/bf02188777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With the wider availability of magnetic resonance imaging cavernous malformations are being recognised with increasing frequency in those patients presenting with intractable epilepsy. Surgical resection is the treatment of choice. However, because these lesions are usually small and may be located in eloquent areas stereotactic resection should be considered. Stereotactically-guided resection of pathologically verified cavernous angiograms was performed in 10 patients in this series presenting with epilepsy (8 males, 2 females, mean age 32 years). Eight patients presented with medically intractable epilepsy (5 complex partial seizures, 3 grand mal seizures). Of the remaining patients one experienced multiple episodes of haemorrhage and the other headaches (with a non-diagnostic scan) both in association with epilepsy. Pre-operative localisation of the motor strip was determined in one case by functional MRI. Following resection of these lesions all patients experienced improved seizure control with a mean follow-up period of 22 months. The mean postoperative hospital stay was 5.1 days with no surgical complications recorded. We conclude that stereotactically-guided resection offers significant advantages in the management of cavernous malformations. Surgical indications for operative resection would include medically refractory epilepsy, repeated haemorrhage and those cases where there is diagnostic uncertainty.
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Affiliation(s)
- A T Casey
- National Hospital for Neurology and Neurosurgery, London, U.K
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69
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Houtteville JP. The surgery of cavernomas both supra-tentorial and infra-tentorial. Adv Tech Stand Neurosurg 1995; 22:185-259. [PMID: 7495419 DOI: 10.1007/978-3-7091-6898-1_4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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70
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Tratamiento en los angiomas cavernosos. Neurocirugia (Astur) 1995. [DOI: 10.1016/s1130-1473(95)70795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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71
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72
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Missori P, Tarantino R, Delfini R, Lunardi P, Cantore G. Surgical management of orbital cavernous angiomas: prognosis for visual function after removal. Neurosurgery 1994; 35:34-8. [PMID: 7936149 DOI: 10.1227/00006123-199407000-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The authors report the outcome of surgical treatment in a group of 25 patients with cavernous angioma of the orbital cavity. In the majority of cases, good esthetic results were appreciable within a few days of surgery. However, the onset or deterioration of preexisting visual deficits, in spite of the complete preservation of the optic nerve in a third of these patients, draws attention to the need for accurate surgical timing.
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Affiliation(s)
- P Missori
- Department of Neurological Sciences, Neurosurgery, University of Rome La Sapienza, Italy
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73
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Lynch JC, Andrade R, Pereira C, Salomão JF, Duarte F, Carvalho FG, Chadrycki E. [Intracranial cavernous angioma]. ARQUIVOS DE NEURO-PSIQUIATRIA 1994; 52:237-42. [PMID: 7826254 DOI: 10.1590/s0004-282x1994000200015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clinical, radiological and histopathological features of eight cases of symptomatic cavernous angioma are presented. Five patients were being evaluated for seizure, two for mass lesions and one for intracranial hemorrhage. CT and/or MRI detected the lesion in all cases, but there is not a characteristic image for cavernous angioma. Good results were obtained by microsurgical approach to these malformations in seven patients with only one patient suffering a worsening of neurological status after surgery.
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Affiliation(s)
- J C Lynch
- Departamento de Neurocirurgia, Hospital dos Servidores do Estado (HSE), Rio de Janeiro, Brasil
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74
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Fritschi JA, Reulen HJ, Spetzler RF, Zabramski JM. Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir (Wien) 1994; 130:35-46. [PMID: 7725941 DOI: 10.1007/bf01405501] [Citation(s) in RCA: 261] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A retrospective analysis of 139 patients with brain stem cavernous malformations is presented. The material consists of 41 cases from Bern and Phoenix and 98 further well-documented cases from the literature. Sixty-eight patients were male, 70 were female. The average age was 31.8 + 11.8 years. Sixty-two percent of the cavernous malformations were in the pons, 14% were in the mesencephalon, 12% were in the pontomesencephalic and in the pontomedullary junction, and 5% were in the medulla. Eighty-eight percent of the patients showed evidence of recent or previous hemorrhage, 55% had one hemorrhage. 17% had two hemorrhages, and 17% had three or more hemorrhages. Twelve patients died from a hemorrhage, 5 with the first bleeding and 7 with a rebleeding. The minimum bleeding rate was 2.7% per year and the average rebleeding rate 21% per year and per lesion. Most lesions had a diameter between 10 and 30 mm. Increase in size was observed in 12 of the patients; this corresponds to about 21% when only patients with a follow-up of at least one year are considered. In 93 patients the cavernous malformation was removed operatively while in 30 patients the lesion was not removed. In the group with conservative management at the end of the observation period (up to 25 and 32 years), 66.6% had no or only a slight neurological deficit, 6.7% were moderately disabled, 6.7% were completely dependent, and 20% had died. In the group treated surgically 83.9% had no or only a slight neurological deficit, and 15% were moderately disabled. One patient remained severely disabled, no patient died. The limitations of the retrospective nature of this study are stressed.
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Affiliation(s)
- J A Fritschi
- Department of Neurosurgery, University of Bern, Switzerland
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75
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Katayama Y, Tsubokawa T, Maeda T, Yamamoto T. Surgical management of cavernous malformations of the third ventricle. J Neurosurg 1994; 80:64-72. [PMID: 8271024 DOI: 10.3171/jns.1994.80.1.0064] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to determine adequate therapeutic approaches for cavernous malformations of the third ventricle, the authors reviewed a series of five such malformations managed at their institution and nine others reported in the literature. Four subgroups were identified in terms of the site of origin and could be characterized by different clinical manifestations: visual field defects and endocrine function deficits in patients with malformations in the suprachiasmatic region (six cases); symptoms caused by hydrocephalus in those with malformations in the foramen of Monro region (five cases); and deficits of short-term memory in those with malformations in the lateral wall (two cases) or of the floor of the third ventricle (one case). Unlike cavernous malformations at other locations, malformations of the third ventricle frequently demonstrated rapid growth (43%) and mass effects (71%). The surgical or autopsy findings suggested that the growth was attributable to repeated intralesional hemorrhages. Extralesional hemorrhage was also not uncommon, occurring in 29% of patients. Such tendencies require the adoption of a more aggressive approach to this particular group of cavernous malformations as compared to those in other locations. The risks of regrowth and extralesional hemorrhage appear to be reduced only by complete excision. The surgical approaches adopted should be aimed at providing the best access to the site where the malformation has arisen. The translamina terminalis approach for cavernous malformations in the suprachiasmatic region, the transventricular or transcallosal interfornicial approaches for those in the foramen of Monro region and the transvelum interpositum approach for those in the lateral wall or the floor of the third ventricle appear to be appropriate. In order to select the adequate surgical approach, precise diagnosis of the site of origin is crucial. In addition to neuroimaging techniques, the patient's initial symptoms provide valuable information.
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Affiliation(s)
- Y Katayama
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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76
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77
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Robinson JR, Awad IA, Masaryk TJ, Estes ML. Pathological heterogeneity of angiographically occult vascular malformations of the brain. Neurosurgery 1993; 33:547-54; discussion 554-5. [PMID: 8232794 DOI: 10.1227/00006123-199310000-00001] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
There is considerable confusion in the literature regarding the pathological substrates of angiographically occult vascular malformations (AOVMs) of the brain and their clinical significance. We retrospectively reviewed the cases of 34 consecutive patients with AOVMs undergoing surgical excision at a single institution during a 10-year period. Pathological specimens were reexamined, and the lesions were classified according to strict histopathological criteria. There were 21 cavernous malformations, 3 arteriovenous malformations, 3 venous malformations, 2 capillary malformations, and 5 mixed (pathologically heterogeneous) lesions. The initial pathological diagnostic report had been imprecise or had misidentified the lesion type in 18 of the 34 cases (53%), most commonly labeling a cavernous malformation as an arteriovenous malformation or not recognizing mixed features within the same lesion. Clinical presentation (including hemorrhage) and outcome were not significantly different among the various lesion types. Preoperative diagnostic imaging included a variety of modalities that were introduced or evolved during the period of the study and generally suggested a suspected vascular malformation but did not predict pathological subtypes. Acute hematomas in this surgical series made the identification of underlying vascular malformations highly speculative. We conclude that the majority of AOVMs requiring surgical intervention are cavernous malformations, although there was a notable pathological heterogeneity of the remaining lesions. Histopathological subtypes of AOVMs are not associated with unique clinical or radiographic features.
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Affiliation(s)
- J R Robinson
- Section of Cerebrovascular Surgery, Cleveland Clinic Foundation, Ohio
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78
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Kawagishi J, Suzuki M, Kayama T, Yoshimoto T. Huge multilobular cavernous angioma in an infant: case report. Neurosurgery 1993; 32:1028-30; discussion 1030-1. [PMID: 8327078 DOI: 10.1227/00006123-199306000-00026] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The authors encountered a rare case of multilobular cavernous angioma arising from the paraventricular region in an infant. Total resection of the angioma, which was 8 cm in diameter, was performed. The patient showed no neurological deficit. Although 22 cases in infants have previously been reported, this is the largest cavernous angioma and it is especially rare because of its multilobular configuration.
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Affiliation(s)
- J Kawagishi
- Division of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
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79
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Huge Multilobular Cavernous Angioma in an Infant. Neurosurgery 1993. [DOI: 10.1097/00006123-199306000-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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80
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81
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Canavero S. Intramedullary cavernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 1993; 32:692-3. [PMID: 8474663 DOI: 10.1097/00006123-199304000-00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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82
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Acciarri N, Padovani R, Giulioni M, Gaist G, Acciarri R. Intracranial and orbital cavernous angiomas: a review of 74 surgical cases. Br J Neurosurg 1993; 7:529-39. [PMID: 8267890 DOI: 10.3109/02688699308995075] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present a surgical series of 74 patients (30 males and 44 females) with pathologically verified cavernous angiomas of the intracranial and orbital compartments. Patients were admitted between 1975 and 1991; six had a family history of cerebral cavernomas, and two had multiple (two) lesions. The 76 malformations were located as follows: 57 were in the cerebral hemispheres, four in the supratentorial ventricles, one was in the middle cranial fossa, two were in the brain stem, five in the cerebellum and seven in the orbits. Seizures and focal neurological deficits, and decrease of visual acuity with exophthalmus, were the main clinical signs observed in patients with intracranial and orbital cavernomas, respectively. Sixteen patients (21.6%) had a clinically significant haemorrhage attributable to the cavernous angioma. A number of these vascular malformations were misdiagnosed by computed tomography. In the last 10 years magnetic resonance imaging has been the most sensitive method for detecting these lesions. Seventy-four of the 76 diagnosed cavernomas were treated surgically: a complete excision was obtained in 68 patients; in two patients with multiple lesions only those causing symptoms were removed. Surgery for the 10 deep lesions was aided considerably by stereotactic localization. Two patients died in the immediate postoperative course. The overall outcome was good in 66 of the 72 remaining patients, resulting in improved seizure control or lessened neurological deficit.
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Affiliation(s)
- N Acciarri
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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83
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Lorenzana L, Cabezudo JM, Porras LF, Polaina M, Rodriguez-Sanchez JA, Garcia-Yagüe LM. Focal dystonia secondary to cavernous angioma of the basal ganglia: case report and review of the literature. Neurosurgery 1992; 31:1108-11; discussion 1111-2. [PMID: 1470322 DOI: 10.1227/00006123-199212000-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The case of a young woman with focal dystonia of the hand due to a cavernous angioma of the basal ganglia is presented. The lesion involved the anterior third of the lentiform nucleus and a large portion of white matter anterior to this nucleus and lateral to the head of the caudate, as shown by magnetic resonance imaging; it was completely removed through a computed tomography-assisted stereotactic craniotomy by microsurgical technique, resulting in the cure of the patient. These facts support the pathophysiological hypothesis of a disruption of the striatopallidothalamic projection to the premotor cortex as the cause of symptomatic dystonia. A review of the reported cases of cavernous angiomas of the deep cerebral gray nuclei shows that this is the first case of cavernous angioma associated with movement disorder.
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Affiliation(s)
- L Lorenzana
- Seccion de Neurocirugía, Hospital Universitario Infanta Cristina, Universidad de Extremadura, Badajoz, Spain
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84
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Focal Dystonia Secondary to Cavernous Angioma of the Basal Ganglia. Neurosurgery 1992. [DOI: 10.1097/00006123-199212000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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85
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Affiliation(s)
- P S Bergeson
- Department of Pediatrics, Phoenix Children's Hospital, AZ 85006
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86
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George B, Celis-Lopez M, Kato T, Lot G. Arteriovenous malformations of the posterior fossa. Acta Neurochir (Wien) 1992; 116:119-27. [PMID: 1502945 DOI: 10.1007/bf01540864] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AVMs of the posterior fossa are reviewed on the basis of personal experience of 47 cases including 2 venous angiomas, 7 cavernous angiomas, 5 arteriovenous fistulas and 33 true arteriovenous malformations and of the few series reported in the literature. MRI is now an indispensable tool to define the exact localization of any malformation. Combined with angiography, it permits one to choose the most adequate therapeutic strategy and the best surgical approach. Radical cure is to be contemplated in most cases considering the often dramatic consequences of bleeding at the infratentorial level. Deep AVMs and moreover cavernous angiomas, even those located in highly functional structures such as the brain stem, can now be discussed for treatment. Encouraging results have already been obtained using, alone or in association, the recently advanced modalities of treatment: interventional neuroradiology, radiosurgery, and microsurgery.
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Affiliation(s)
- B George
- Department of Neurosurgery, Hôpital Lariboisière, Paris, France
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87
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Sakai N, Yamada H, Nishimura Y, Shirakami S, Futamura A, Andoh T. Intracranial cavernous angioma in the 1st year of life and a review of the literature. Childs Nerv Syst 1992; 8:49-52. [PMID: 1576609 DOI: 10.1007/bf00316563] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three cases of symptomatic cavernous angioma occurring in the 1st year of life are presented. All three patients were treated with radical extirpation. Postoperatively, two of them improved, but the third died due to cerebral herniation secondary to recurrence of bleeding of the lesion. The clinical characteristics of cavernous angioma in the 1st year of life are briefly discussed and a review of the literature presented, including 16 previous cases operated on directly.
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Affiliation(s)
- N Sakai
- Department of Neurosurgery, Gifu University School of Medicine, Japan
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88
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Ferrante L, Palma L, d'Addetta R, Mastronardi L, Acqui M, Fortuna A. Intracranial cavernous angioma. Neurosurg Rev 1992; 15:125-33. [PMID: 1635626 DOI: 10.1007/bf00313508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report 14 cases of intracranial cavernous angioma, analyzing the clinical features, with special reference to the risk of bleeding, radiological images and treatment in these and in 153 published cases, 167 in all. Cerebral hemorrhage occurred in 44%: typical (intraparenchymal or subarachnoid) in 24.6%, and masked by epilepsy, headache or neurological deficits in 19.2%. In patients with the typical hemorrhagic pattern posthemorrhagic mortality was 12.2%. Of the patients who had a hemorrhage 42.5% were left with more or less disabling neurological deficits, and 16.4% had a rebleed. In discussing treatment we consider four groups of intracranial cavernous angioma: A) symptomatic in a zone of low surgical risk; B) asymptomatic with low surgical risk; C) symptomatic with high surgical risk; D) asymptomatic with high surgical risk. The treatment is surgical, except in the high risk asymptomatic variety, best followed initially with sequential CT scan and MRI and then considered for surgery if the lesion becomes symptomatic, increases in size or presents neuroradiological signs of bleeding.
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Affiliation(s)
- L Ferrante
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
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89
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Abstract
Intradural cavernomas are rare vascular lesions of the spinal cord. Four cases of histologically verified cavernomas of the cord are reported, of which two were extramedullary and two were intramedullary in location. Progressive neurological deficit was the presenting feature in three cases while one patient had a rapid evolution of neurological deficits and was found at surgery to have had bled from the extramedullary lesion. All the patients were subjected to surgery and total excision of the cavernomas was carried out in each case. While two patients improved after surgery the other two remained static. The available literature on spinal cord cavernomas is reviewed.
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Affiliation(s)
- R Sharma
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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90
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Abstract
The incidence and natural history of the cavernous angioma have remained unclear in part because of the difficulty of diagnosing and following this lesion prior to surgical excision. The introduction of magnetic resonance (MR) imaging has improved the sensitivity and specificity of diagnosing and following this vascular malformation. Seventy-six lesions with an MR appearance typical of a presumed cavernous angioma were discovered in 66 patients among 14,035 consecutive MR images performed at the Cleveland Clinic between 1984 and 1989. Follow-up studies in 86% of the cases over a mean period of 26 months provided 143 lesion-years of clinical survey of this condition. The most frequent presenting features were seizure, focal neurological deficit, and headache. While most lesions exhibited evidence of occult bleeding on MR imaging, there was overt hemorrhage in seven of the 57 symptomatic patients and only one overt hemorrhage occurred during the follow-up interval. The annualized bleeding rate was 0.7%. Analysis of the hemorrhage group revealed a significantly greater risk of overt hemorrhage in females. Pathological confirmation of cavernous angioma was obtained in all 14 surgical cases. This information assists in rational therapeutic planning and prognosis in patients with MR images showing lesions suggestive of cavernous angioma.
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Affiliation(s)
- J R Robinson
- Department of Neurological Surgery, Cleveland Clinic Foundation, Ohio
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91
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Abstract
Since the availability of CT diagnosis 23 cases of intraventricular cavernous angioma (IVCA) have been published in the literature. Three additional cases have been operated upon in our Department. Based on these 26 cases the clinical data, radiological findings, treatment and outcome of IVCAs are reviewed.
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Affiliation(s)
- M Tatagiba
- Neurochirurgische Klinik, Krankenhaus Nordstadt, Hannover, Federal Republic of Germany
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92
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Hillman J, Bynke O. Solitary extradural cavernous hemangiomas in the spinal canal. Report of five cases. SURGICAL NEUROLOGY 1991; 36:19-24. [PMID: 2053068 DOI: 10.1016/0090-3019(91)90127-u] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Five cases of solitary extrathecal cavernous hemangioma in the spinal canal are reported. In one case, two coexistent massive cerebral venous medullary malformations were found. The symptomatology and prognosis of extrathecal spinal cavernous hemangiomas are discussed, as is the significance of various diagnostic measures. The patient material further permitted a rough calculation of the incidence of symptomatic extrathecal cavernous hemangiomas in the spinal canal.
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Affiliation(s)
- J Hillman
- Department of Neurology, University Hospital, Linköping, Sweden
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93
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Requena I, Arias M, López-Ibor L, Pereiro I, Barba A, Alonso A, Montón E. Cavernomas of the central nervous system: clinical and neuroimaging manifestations in 47 patients. J Neurol Neurosurg Psychiatry 1991; 54:590-4. [PMID: 1895122 PMCID: PMC1014427 DOI: 10.1136/jnnp.54.7.590] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Forty seven cases of central nervous system cavernous angioma (21 males and 26 females) are described. The main clinical signs were epilepsy and brainstem syndromes. Digital subtraction intra-arterial angiography, when used, failed to reveal cavernoma. CT detected many of the lesions, but the most successful supplementary diagnostic procedure was MRI which produces highly characteristic images of cavernous angioma. The diagnosis of cavernous angioma was confirmed in the 18 cases in which the tumour was removed surgically.
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Affiliation(s)
- I Requena
- Hospital Provincial, Santiago de Compostela, Spain
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94
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Mazza C, Scienza R, Beltramello A, Da Pian R. Cerebral cavernous malformations (cavernomas) in the pediatric age-group. Childs Nerv Syst 1991; 7:139-46. [PMID: 1878867 DOI: 10.1007/bf00776709] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cavernomas are vascular malformations composed of a compact mass of sinusoidal-type vessels that are immediately contiguous with one another and have no intervening parenchyma. Cavernous malformations were previously held to be a rare pathology occurring predominantly in adults. New neuroradiological techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate, on the contrary, that these lesions are also more frequent during childhood than was previously thought. In our institution we observed 17 cases of cavernous malformations in patients aged between 18 months and 16 years, 16 of whom were diagnosed after 1982. In 4 of these cases there was a documented familial history; in 2 multiple malformations were present. The most common site was the subcortical frontal region, but in 1 case the malformation was located in the pineal region. The most frequent (in 12 cases) initial symptom was hemorrhage, with the characteristics of an intracerebral hematoma. In 4 cases the initial symptom consisted of epileptic fits and 2 of these patients subsequently suffered hemorrhage. In one case the symptoms observed were those of an expansile process. All our patients underwent cerebral angiography and only in 1 case did this show a vascular abnormality. CT, performed in 16 patients, gave positive results in all cases. MRI, performed in 12 patients, gave highly significant images in all cases. Radical surgical removal of the malformation was performed in 15 of the 17 patients, and the results can be considered excellent in the majority of cases. Cavernous malformations are, therefore, more frequent lesions than had previously been thought, especially in pediatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Mazza
- Department of Neurosurgery, City Hospital Borgo Trento, Verona, Italy
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95
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LeDoux MS, Aronin PA, Odrezin GT. Surgically treated cavernous angiomas of the brain stem: report of two cases and review of the literature. SURGICAL NEUROLOGY 1991; 35:395-9. [PMID: 2028390 DOI: 10.1016/0090-3019(91)90053-c] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two cases of surgically treated brain stem cavernous angiomas are presented. The previously reported cases are reviewed and the clinical features, radiographic appearance, and treatment of this condition are discussed. Symptomatic brain stem cavernous angiomas should be treated surgically and can be removed with good outcomes.
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Affiliation(s)
- M S LeDoux
- Division of Neurosurgery, University of Alabama, School of Medicine, Birmingham 35294
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96
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Abstract
Vascular malformations of the brain stem are a histologically heterogenous collection of lesions which most often present with sudden and progressive neurologic deficit related to haemorrhage. Since 1987 the authors have treated eleven cases of brain stem vascular malformation. Seven of the patients were treated with complete surgical extirpation of the haematoma and malformation because of progressive neurologic deficit. Four additional patients made a full neurologic recovery and are being carefully observed for signs suggestive of the need for surgical treatment. Complete surgical excision of brain stem vascular malformations is mandatory for patients with progressive neurologic deficit related to recurrent haemorrhage.
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Affiliation(s)
- S M Weil
- University of Cincinnati, Department of Neurosurgery, Ohio
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97
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Kashiwagi S, van Loveren HR, Tew JM, Wiot JG, Weil SM, Lukin RA. Diagnosis and treatment of vascular brain-stem malformations. J Neurosurg 1990; 72:27-34. [PMID: 2294181 DOI: 10.3171/jns.1990.72.1.0027] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vascular malformations are a common cause of spontaneous brain-stem hemorrhage in young normotensive individuals. These lesions are no longer cryptic. Magnetic resonance (MR) imaging has renewed interest in the treatment of this disorder because of the precise accuracy in diagnosis and localization of these lesions that it affords. The MR image demonstrates characteristic findings of multiple hemorrhages of varying ages surrounded by a hypointense peripheral zone of hemosiderin. Five cases of vascular brain-stem malformation diagnosed with MR imaging are described. The vascular malformations could be demonstrated as "flow void" areas in three cases. Three patients were treated surgically and vascular malformations were confirmed: all three patients improved postoperatively. Two patients were treated nonsurgically; one of these recovered from a second hemorrhage and the other experienced neurological deterioration after a single hemorrhage. High-energy radiotherapy was not effective for the one vascular malformation treated by this method. This experience suggests that surgical exploration should be considered for vascular brain-stem malformations when the diagnosis is confirmed by MR criteria and the clinical course and lesion are both progressive in character.
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Affiliation(s)
- S Kashiwagi
- Department of Neurosurgery, University of Cincinnati College of Medicine, Ohio
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98
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Buckingham MJ, Crone KR, Ball WS, Berger TS. Management of cerebral cavernous angiomas in children presenting with seizures. Childs Nerv Syst 1989; 5:347-9. [PMID: 2611768 DOI: 10.1007/bf00271890] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Until recently intracranial cavernous angiomas were thought to be rare vascular malformations that usually presented in adulthood as an intracerebral hemorrhage, an expanding mass lesion, or with the new onset of seizures. Prior to the advent of computed tomography (CT), and more recently magnetic resonance imaging (MRI), their diagnosis in childhood was extremely rare. However, the CT and MRI features of cavernous angioma are quite distinctive and allow early diagnosis and treatment. Advances in surgical techniques permit successful removal of these potentially devastating lesions and amelioration of the associated seizure disorder. Seven children with cerebral cavernous angiomas have been treated at the Children's Hospital Medical Center since 1980. Six children presented with seizures and one with an intracerebral hemorrhage. All had characteristic findings on CT and/or MRI and underwent surgical excision of symptomatic lesions. Intraoperative sonography, electrocorticography, and cortical mapping were used when indicated and were found to be helpful in the surgical management of these patients. Our experience suggests that symptomatic cerebral cavernous angiomas in children are not as rare as previously thought and that surgical treatment using modern neurosurgical techniques is both safe and appropriate and can be helpful in the management of associated seizures.
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Affiliation(s)
- M J Buckingham
- Department of Pediatric Neurosurgery, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
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99
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Abstract
We studied a family in which the proband had an acute chiasmal syndrome secondary to a cavernous angioma of the optic nerve and chiasm. A brain magnetic resonance imaging scan indicated additional asymptomatic intracerebral cavernous angioma, and several of the patient's relatives were found to have various central nervous system vascular malformations. Magnetic resonance imaging may distinguish, noninvasively, symptomatic and asymptomatic carriers of cavernous angiomas and further delineate their inheritance patterns. Asymptomatic cavernous angiomas of the central nervous system are best followed without intervention, whereas symptomatic patients should be treated on an individual basis, depending on the location of lesion and the risk of surgical removal.
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Affiliation(s)
- J R Corboy
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
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100
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Imakita S, Nishimura T, Yamada N, Naito H, Takamiya M, Yamada Y, Kikuchi H, Yonekawa Y, Sawada T, Yamaguchi T. Cerebral vascular malformations: applications of magnetic resonance imaging to differential diagnosis. Neuroradiology 1989; 31:320-5. [PMID: 2797424 DOI: 10.1007/bf00344175] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Twelve patients with cerebral vascular malformations (5 cavernous angiomas, 1 thrombosed arteriovenous malformation, and 6 venous angiomas) were studied with magnetic resonance (MR) imaging. All lesions were clearly depicted. Characteristic MR findings were obtained mainly on T2-weighted images: a markedly low intensity area was always seen. The margins of arteriovenous malformation (AVM) and venous angioma were irregular while those of cavernous angioma were smooth in all planes on T2-weighted images. Gradient-echo (GrE) pulse sequences were more sensitive than T2-weighted spin echo (SE) in lesion detection. MR imaging could play an important role in the differential diagnosis of cerebral vascular malformations.
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Affiliation(s)
- S Imakita
- Department of Radiology, National Cardiovascular Center, Osaka, Japan
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