1
|
Eng-Chuan S, Kritsaneepaiboon S, Kaewborisutsakul A, Kanjanapradit K. Giant intraventricular and paraventricular cavernous malformations with multifocal subependymal cavernous malformations in pediatric patients: Two case reports. World J Radiol 2020. [DOI: 10.4329/wjr.v12.i2.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
2
|
Eng-Chuan S, Kritsaneepaiboon S, Kaewborisutsakul A, Kanjanapradit K. Giant intraventricular and paraventricular cavernous malformations with multifocal subependymal cavernous malformations in pediatric patients: Two case reports. World J Radiol 2020; 12:10-17. [PMID: 32180903 PMCID: PMC7061262 DOI: 10.4329/wjr.v12.i2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Giant cavernous malformation (GCM) is rarely found in intraventricular or paraventricular locations.
CASE SUMMARY We present two cases of 6-mo and 21-mo boys with intraventricular and paraventricular GCMs including a literature review focused on location and imaging findings. Characteristic magnetic resonance imaging findings such as multicystic lesions and a hemosiderin ring or bubbles-of-blood appearance can assist in the differential diagnosis of a hemorrhagic intraventricular and/or paraventricular mass.
CONCLUSION Multifocal intraventricular and/or paraventricular GCM in small children is rare. The characteristic magnetic resonance imaging findings can help to differentiate GCMs from other intraventricular tumors.
Collapse
Affiliation(s)
- Suwadee Eng-Chuan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Anukoon Kaewborisutsakul
- Neurosugery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| |
Collapse
|
3
|
Baldo S, Magrini S, Tacconi L. Purely Endoscopic Resection of Cavernoma of the Septum Pellucidum. Surg J (N Y) 2019; 5:e42-e45. [PMID: 31214656 PMCID: PMC6579726 DOI: 10.1055/s-0039-1693082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/10/2019] [Indexed: 11/02/2022] Open
Abstract
The intraventricular location of a cavernoma is a rare entity and accounts for approximately 2.5% of all cavernomas of the central nervous system. They are commonly found in the lateral ventricle followed by the third and fourth ventricles. The location in the septum pellucidum is rare, and only four cases have been reported in the international literature. An open craniotomy was performed in all these cases. To the best of our knowledge, this is the first case of a cavernoma of the septum pellucidum successfully resected using a purely endoscopic transventricular approach.
Collapse
Affiliation(s)
- Sara Baldo
- Department of Neurosurgery, University Hospital of Trieste, Trieste, Italy
| | - Salima Magrini
- Department of Neurosurgery, University Hospital of Trieste, Trieste, Italy
| | - Leonello Tacconi
- Department of Neurosurgery, University Hospital of Trieste, Trieste, Italy
| |
Collapse
|
4
|
Multiple Intracranial Cavernous Angiomas With a Trigonal Cavernous Angioma Mimicking Glioma. J Craniofac Surg 2018; 29:e635-e637. [PMID: 29621076 DOI: 10.1097/scs.0000000000004544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intracranial cavernous angiomas (CAs) are hamartomatous vascular malformations consisting of thin-walled vascular channels located within the brain, but typically lacking intervening neural parenchyma, large feeding arteries, or draining veins. The CAs occurring in the ventricular system are rare, with an incidence of 2.5% to 10.3% of the intracranial CAs, and those arising from the trigone of the lateral ventricle are even rarer. Till now, there are <20 patients with trigonal CAs have been reported in the English literature. In this study, the authors describe an extremely rare case of multiple intracranial CAs with a trigonal CA mimicking glioma. Furthermore, they also discuss the characteristic aspects of symptoms, radiologic findings, diagnosis, and treatment of this benign lesion.
Collapse
|
5
|
Wang C, Zhao M, Deng X, Wang J, Jiang Z, Zhao J. Clinical features and neurosurgical treatment of trigonal cavernous malformations. Neurosurg Rev 2017; 41:877-890. [PMID: 29280021 DOI: 10.1007/s10143-017-0938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
The goals of this study were to analyze the incidence, clinical manifestations, neuroimaging findings, surgical treatments, and neurological outcomes of trigonal cavernous malformations (TCMs). Among 1395 cases of intracranial and intraspinal cavernous malformations (CMs) surgically treated between 2003 and 2016 at Beijing Tiantan Hospital, a series of 12 patients with TCM was chosen for analysis and their records were reviewed. We also performed an exhaustive literature search using PubMed to identify all previously reported cases in the literatures. TCMs accounted for 0.86% of the entire series of the central nervous system (CNS) CMs. The case series consisted of five male and seven female patients (ratio 1:1.4), with an average age at presentation of 32.9 years (7-53 years). In all the cases, headache was the most common initial symptom (66.7%). Complete resection without surgical mortality was achieved in all the cases. Postoperative complications included fever, lower limb weakness, sensory aphasia, and calculational capacity declination. Follow-up period after diagnosis was 15 to 74 months (mean 48.3 months); no patient was lost to follow-up. All the patients were considered to be in excellent clinical condition. TCMs are rare lesions; they can reach large size, and their symptoms and signs commonly resulted from mass effect. Surgical intervention is the treatment of choice for TCMs; patients can obtain favorable neurological outcomes after complete resection.
Collapse
Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
| |
Collapse
|
6
|
Neurosurgical management of cavernous malformations located at the foramen of Monro. Neurosurg Rev 2017; 41:799-811. [DOI: 10.1007/s10143-017-0930-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/29/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
|
7
|
Feletti A, Dimitriadis S, Pavesi G. Cavernous Angioma of the Cerebral Aqueduct. World Neurosurg 2016; 98:876.e15-876.e22. [PMID: 27890756 DOI: 10.1016/j.wneu.2016.11.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among the rare intraventricular cavernomas, purely intra-aqueductal cavernomas are exceptionally rare. CASE DESCRIPTION A 62-year-old patient presented with progressive headache, memory loss, gait instability, and urinary incontinence. Magnetic resonance imaging showed the presence of a mass lesion located in the lumen of the cerebral aqueduct, associated with triventricular hydrocephalus. CONCLUSIONS We discuss the rationale that led us to treat hydrocephalus with neuroendoscopy, which offered the possibility to directly inspect the intra-aqueductal lesion, make the diagnosis of cavernoma, and treat symptoms resulting from hydrocephalus without increasing the risk of bleeding.
Collapse
Affiliation(s)
- Alberto Feletti
- Department of Neurosurgery, NOCSAE Hospital of Modena, Modena, Italy.
| | | | - Giacomo Pavesi
- Department of Neurosurgery, NOCSAE Hospital of Modena, Modena, Italy
| |
Collapse
|
8
|
Chourmouzi D, Kaltsikis I, Zountsas B, Drevelegas A. Third ventricle cavernoma associated with multiple intracerebral cavernomas. Acta Neurol Belg 2013; 113:99-101. [PMID: 22798034 DOI: 10.1007/s13760-012-0078-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/23/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Danai Chourmouzi
- Diagnostic Radiology Department, Interbalcan Medical Center, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
9
|
Ohbuchi H, Osaka Y, Ogawa T, Nanto M, Nakahara Y, Katsura K, Tenjin H, Kasuya H. Trigonal cavernous malformation with intraventricular hemorrhage: a case report and literature review. THE JOURNAL OF MEDICAL INVESTIGATION 2012; 59:275-9. [PMID: 23037200 DOI: 10.2152/jmi.59.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We reported a case of trigonal cavernous malformation (CM) with intraventricular hemorrhage. This 67-year-old woman experienced sudden onset of loss of consciousness and her Glasgow Coma Scale (GCS) was 5 points (E1V1M3) on admission. CT scan demonstrated intraventricular hemorrhage and acute hydrocephalus. Angiography did not demonstrate any vascular abnormality. Ventricular drainage was performed for acute hydrocephalus and the postoperative course was good. CT showed a hyperdense lesion in the left trigone, which was contrast-enhanced on T1-weighted MR. Removal of CM was performed via the left middle temporal sulcus. We conducted a Pub Med search for trigonal CM and found 17 cases. Herein we discuss the symptoms, CT and MR findings and treatment.
Collapse
Affiliation(s)
- Hidenori Ohbuchi
- Department of Neurosurgery, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Peltier J, Capel C, Nicot B, Baroncini M, Fichten A, Toussaint P, Desenclos C, Lefranc M, Le Gars D, Lejeune JP. [Rare tumors of the lateral ventricle. Review of the literature]. Neurochirurgie 2011; 57:225-9. [PMID: 22030165 DOI: 10.1016/j.neuchi.2011.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/11/2011] [Indexed: 10/15/2022]
Abstract
Metastases of lateral ventricle (LV) are attached to choroidal plexus. Primary source is cancer of kidney. Two thirds of patients are male. Oligodendrogliomas occur in young females. Signs of increased intracranial pressure are a constant feature. These tumors are found in anterior portion of the LV with severe enhancement and clumped calcifications. Treatment is surgical. Cavernomas have a preponderance of rapid growth with a bleeding revelation. Seizures are rare. Rebleeding is frequent and justifies a surgical treatment. Schwannomas are a rare entity in which the majority of patients are very young. MRI shows calcifications, cystic components and a strong enhancement. They are limited to sporadic cases, never associated with neurofibromatosis. Arachnoid cysts are located in the atrium and/or in the occipital horn. Patients are young (mean age < 40 years). MRI demonstrates an intracystic lesion with signal intensity similar to the CSF. Best treatment is an endoscopic fenestration. Epidermoid cysts occur in third decade. These pearly tumors appear isointense or a little hyperintense on T1-weighted imaging, very characteristic. They are enhanced after gadolinium injection and appear strongly hyperintense on T2-weighted imaging. An incomplete removal with a thorough long-term follow-up is necessary. Cavernomas of LV are hyperintense on T1- and T2-weighted imaging. They have a bleeding risk of 25 to 45%. Therefore, they must be operated.
Collapse
Affiliation(s)
- J Peltier
- Service de neurochirurgie, hôpital Nord, CHU d' Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kivelev J, Niemelä M, Kivisaari R, Hernesniemi J. Intraventricular cerebral cavernomas: a series of 12 patients and review of the literature. J Neurosurg 2010; 112:140-9. [DOI: 10.3171/2009.3.jns081693] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Object
Intraventricular cavernomas (IVCs) occur in only 2–10% of patients with cerebral cavernomas. Reports concerning IVC are scarce and are limited mostly to sporadic case reports. In this paper, the authors present a series of 12 patients with IVCs that were treated at a single neurosurgical department. In addition, the authors reviewed the literature.
Methods
All clinical data were analyzed retrospectively. Follow-up questionnaires were sent to all patients. Outcome was assessed using the Glasgow Outcome Scale. The authors also conducted a PubMed search and found 77 cases of IVC.
Results
The patients' median age was 47 years, and the male/female ratio was 2:1. A cavernoma occurred in the lateral ventricle in 6 patients, in another 5 it was in the fourth ventricle, and 1 had a lesion in the third ventricle. Almost all patients presented with acute headache on admission and in more than half, the symptoms were related to cavernoma bleeding. In total, 8 rebleedings occurred in 5 patients during a median of 0.4 years. Three patients with a cavernoma of the fourth ventricle presented with a cranial nerve deficit. In 8 cases, a cavernoma was surgically treated an average of 1.3 years after the diagnosis. Only 1 patient underwent surgery in the acute phase after a major intraventricular/intracerebral hemorrhage. The median follow-up time was 2 years. No patient was lost to follow-up, and no patient died. In total, on follow-up 9 patients improved and 3 had a persistent neurological deficit, of which 2 existed before surgery.
Conclusions
In the present series, the IVCs had a high tendency for rehemorrhage. Surgery is advocated when hemorrhages are frequent, and the mass effect causes progressive neurological deficits. Microsurgical removal of the IVC is safe, but in the fourth ventricle it can carry increased risk for cranial nerve deficits.
Collapse
|
12
|
Stavrinou LC, Stranjalis G, Flaskas T, Sakas DE. Trigonal cavernous angioma: a short illustrated review. Acta Neurochir (Wien) 2009; 151:1517-20. [PMID: 19300903 DOI: 10.1007/s00701-009-0252-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 01/26/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Intraventricular cavernomas are rare. Even more rare are those presenting in the trigone of the lateral ventricles. METHODS We performed a search of the literature of the last 30 years and identified all cases of intraventricular cavernous angiomas. Trigonal cavernomas were separately identified and analysed. Our search yielded a total of 13 trigonal cavernomas. RESULTS Of a total of 61 intraventricular cases, 13 were located in the trigone of the lateral ventricles. The most prominent presenting symptom was intracranial hypertension (68.9%), followed by seizures (18.2%) and hemorrhage (13.1%).The literature review revealed a trend of intraventricular cavernomas to present with intracranial hypertension rather than seizures or focal neurologic deficit, unlike their intraparenchymal counterparts. We feel that this difference has received little attention in the international literature. We discuss a possible pathogenetic mechanism for the presence of intracranial hypertension and address different aspects of diagnosis and treatment of this benign lesion. CONCLUSIONS Trigonal cavernomas are benign lesions that have an excellent outcome after radical excision. Symptoms and signs of intracranial hypertension and hydrocephalus may be the prominent initial presentation of this rare ailment.
Collapse
Affiliation(s)
- L C Stavrinou
- Department of Neurosurgery, University of Athens Medical School, Evangelismos General Hospital, Athens 115 21, Greece.
| | | | | | | |
Collapse
|
13
|
Alp R, Alp Sİ, Üre H. Cavernous Hemangioma: A Rare Cause for Secondary Parkinsonism: A Case Report. Int J Neurosci 2009; 119:2112-7. [DOI: 10.1080/00207450903139648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Carrasco R, Pedrosa M, Pascual JM, Navas M, Liberal R, Sola RG. Cavernous angiomas of the lateral ventricles. Acta Neurochir (Wien) 2009; 151:149-54. [PMID: 19194650 DOI: 10.1007/s00701-009-0186-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 12/30/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cavernous angiomas are vascular malformations which rarely involve the cavities of the lateral ventricles. Knowledge of the specific clinical and neuroradiological features displayed by these lesions is limited by the scarcity of patients included in the reported series. OBJECTIVE AND METHODS The aim of this study was to compile and analyse the epidemiological, clinical, neuroradiological and surgical characteristics of these lesions as provided by the well-described examples reported in the scientific literature. A total of 49 were gathered, including three patients operated on recently in our Department. FINDINGS AND CONCLUSIONS Cavernomas developing within the ventricular cavities attain a larger size than parenchymal counterpart lesions, causing symptoms and signs derived mainly from the mass effect. The characteristic parenchymal hypointense rim is less frequently identified on T2-weighted echo-gradient MRI sequences. Total surgical excision is the treatment of choice for these lesions, yet the surgical routes employed may still be associated with a high rate of neurological complications.
Collapse
Affiliation(s)
- Rodrigo Carrasco
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
15
|
Jin SC, Ahn JS, Kwun BD, Kwon DH. Intraventricular cavernous malformation radiologically mimicking meningioma. J Korean Neurosurg Soc 2008; 44:345-7. [PMID: 19119474 DOI: 10.3340/jkns.2008.44.5.345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 09/17/2008] [Indexed: 11/27/2022] Open
Abstract
We report a case of trigonal cavernous malformation (CM) radiologically mimicking meningioma. The computed tomographic (CT) head angiography and magnetic resonance imaging (MRI) showed a partially calcified lesion with slight contrast enhancement located in the area of the left atrium of lateral ventricle. The lesion was completely removed using microsurgery with a parieto-occipital transcortical approach. The resected mass was histologically confirmed as CM. CM should be considered as differential diagnosis in case of the atrial mass lesion due to lack of hemosiderin ring characteristically seen other seated CM.
Collapse
Affiliation(s)
- Sung-Chul Jin
- Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | |
Collapse
|
16
|
Prat R, Galeano I. Endoscopic resection of cavernoma of foramen of Monro in a patient with familial multiple cavernomatosis. Clin Neurol Neurosurg 2008; 110:834-7. [PMID: 18584950 DOI: 10.1016/j.clineuro.2008.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 05/06/2008] [Accepted: 05/13/2008] [Indexed: 11/28/2022]
Abstract
Intraventricular cavernomas are extremely infrequent and only 11 cases of cavernous hemangioma to occur at the foramen of Monro have been reported in the literature. This 56 years old patient was admitted with progressive and intractable headache of 10 days of evolution. He was known to suffer familial multiple cavernomatosis. Magnetic resonance imaging (MRI), revealed obstructive hydrocephalus due to a cavernoma located in the area of the left foramen of Monro. Under neuronavigation guidance, complete endoscopic resection of the cavernoma was performed and normal ventricular size achieved. The patient experienced transient recent memory loss that resolved within a month after surgery. In the literature attempted endoscopic resection is reported to be abandoned due to bleeding and ineffectiveness of piecemeal endoscopic resection. In this case, the multiplicity of the lesions made it advisable to resect the lesion endoscopically, to avoid an open procedure in a patient with multiple potentially surgical lesions. Endoscopic resection was uneventful with easy control of bleeding with irrigation, suction, and bipolar coagulation despite dense vascular appearance of the lesion. During the procedure, precise visualization of the vascular structures around the foramen of Monro allowed complete resection with satisfactory control of the instruments. To the best of the authors' knowledge, this is the first published cavernoma of foramen of Monro successfully resected using an endoscopic approach.
Collapse
Affiliation(s)
- Ricardo Prat
- Department of Neurosurgery, Hospital La Fe Avda, Campanar 21, 46009 Valencia, Spain.
| | | |
Collapse
|
17
|
Morrison CE, Nakhutina L. Neuropsychological features of lesion-related epilepsy in adults: an overview. Neuropsychol Rev 2007; 17:385-403. [PMID: 17952606 DOI: 10.1007/s11065-007-9044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/03/2007] [Indexed: 11/26/2022]
Abstract
Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.
Collapse
Affiliation(s)
- Chris E Morrison
- Department of Neurology, Comprehensive Epilepsy Center, New York University Medical Center, 403 E 34th St., 4th Floor, New York, NY, 10016, USA.
| | | |
Collapse
|
18
|
Alves de Sousa A. Cavernomes profonds (corps calleux, intraventriculaires, ganglions de la base, insulaires) et du tronc cérébral. Expérience d'une série brésilienne. Neurochirurgie 2007; 53:182-91. [PMID: 17507054 DOI: 10.1016/j.neuchi.2007.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 03/20/2007] [Indexed: 11/23/2022]
Abstract
With a review of the literature, we report our experience with surgical treatment of deep-seated cavernomas (intraventricular, of the corpus callosum, the capsula interna, the insula and the brain stem). Outcome was good in all nine patients after surgery for deep-seated brain cavernomas. There we also 13 cases of the brain stem cavernomas treated surgically. Of them, nine patients were stabilized or improved, one patient worsened, one patient died and two were lost to follow-up. Whatever the location, surgery should only concern symptomatic or hemorrhagic lesions close to the pia-matter or the ependyma as well as those covered by a thin layer of parenchyma. Neuronavigation and microsurgical procedures are essential in the treatment of deep-seated cavernomas.
Collapse
|
19
|
Chen CL, Leu CH, Jan YJ, Shen CC. Intraventricular cavernous hemangioma at the foramen of Monro: Case report and literature review. Clin Neurol Neurosurg 2006; 108:604-9. [PMID: 15916846 DOI: 10.1016/j.clineuro.2005.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 11/10/2004] [Accepted: 04/26/2005] [Indexed: 11/19/2022]
Abstract
Cavernous hemangiomas rarely occur in the cerebral ventricles. Those occurring at the foramen of Monro are even less frequent. So far, only eight cases of cavernous hemangioma at the foramen of Monro have been reported in the literature. Here, we present a similar case and correlated the radiographic with the histopathologic findings of the patient. A 51-year-old woman was admitted with obstructive hydrocephalus-related symptoms. The computed tomography (CT) and magnetic resonance imaging (MRI) revealed a partly calcified lesion with slight contrast enhancement located in the area of the right foramen of Monro. The lesion was completely removed by surgical resection with a transfrontal transventricular approach. The resected mass was histologically diagnosed as cavernous hemangioma. The patient's symptoms resolved immediately after operation. Cavernous hemangioma at the foramen of Monro in the present case had common MRI features as previously reported. Although MRI can provide initial diagnosis for such unusually localized tumor, it should be confirmed histopathologically.
Collapse
Affiliation(s)
- Chun-Lin Chen
- Department of Neurosurgery, Taichung Veterans General Hospital, 160 Taichung-Kang Road, Sec. 3, Taichung 407, Taiwan ROC
| | | | | | | |
Collapse
|
20
|
Abstract
✓The authors report on a patient who presented with an intraventricular mass located at the level of the foramen of Monro. The clinical presentation and neuroimaging appearance of the mass led to an initial diagnosis of colloid cyst. A neuroendoscopic approach offered a direct view of the ventricular lesion, which was found to be a cavernous angioma partially occluding the foramen of Monro. The lesion was then removed using microsurgery. In this report the authors highlight possible pitfalls in the diagnosis of some lesions of the third ventricle, and the possible advantages of using a combined endoscopic and microsurgical technique when approaching such lesions.
Collapse
|
21
|
Kumar GSS, Poonnoose SI, Chacko AG, Rajshekhar V. Trigonal cavernous angiomas: report of three cases and review of literature. ACTA ACUST UNITED AC 2006; 65:367-71, discussion 371. [PMID: 16531197 DOI: 10.1016/j.surneu.2005.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 08/11/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intraventricular cavernous angiomas are very rare. Only few cases of trigonal angiomas have been reported. CASE DESCRIPTION We report three cases of trigonal cavernous angiomas who presented with raised intracranial pressure or seizures and who underwent total excision with a good recovery. We also review the literature and discuss surgical approaches. CONCLUSION On magnetic resonance imaging, intraventricular cavernous angiomas lack the hemosiderin ring characteristically seen around parenchymal cavernous angiomas. This explains why trigonal cavernous angiomas can mimic malignant neoplasm on imaging, and they should be considered in the differential diagnosis of intraventricular masses. Total excision should be the goal of surgery.
Collapse
Affiliation(s)
- G Samson Sujit Kumar
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu 632004, India
| | | | | | | |
Collapse
|
22
|
Darwish B, Boet R, Finnis N, Smith N. Third ventricular cavernous haemangioma. J Clin Neurosci 2005; 12:601-3. [PMID: 15975791 DOI: 10.1016/j.jocn.2004.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Accepted: 08/06/2004] [Indexed: 10/25/2022]
Abstract
We report a case of a third ventricular cavernous haemangioma (cavernoma). Cavernomas rarely occur within the ventricular system. Only 47 well-documented cases have been reported in the literature, 21 of which were located in the third ventricle. Cavernomas should be considered in the differential diagnosis of third ventricular lesions. Ventriculoscopy is very useful in establishing the diagnosis.
Collapse
Affiliation(s)
- B Darwish
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | | | | | | |
Collapse
|
23
|
Fagundes-Pereyra WJ, Marques JA, Sousa LD, Carvalho GT, Sousa AA. [Cavernoma of the lateral ventricle: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:958-64. [PMID: 11018841 DOI: 10.1590/s0004-282x2000000500029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Cavernous malformations are uncommon lesions that are usually present in the cerebral hemispheres. They occur rarely in the ventricular system, and even more rarely in the lateral ventricle. Only 28 cases have been previously reported in the literature. CASE We present one case of lateral ventricle cavernoma in a 15-years-old female patient, who suffered of mild chronic headache for 8 months, followed by two episodes of sudden intensive headache and stupor with complete recovery after 48 hours. CT scan was performed and revealed a voluminous size, hiperdense mass in the frontal horn of the lateral ventricle. The surgical access to site was through transcallosal interhemisphere approach. The patient had a good recovery without complications. CONCLUSION Although lateral ventricle cavernomas are rare they should be considered in the differential diagnosis of intraventricular tumors. A wrong preoperative diagnosis has sometimes induced a wrong therapy, such as radiotherapy, for these surgically curable benign lesions.
Collapse
Affiliation(s)
- W J Fagundes-Pereyra
- Santa Casa de Belo Horizonte, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brasil.
| | | | | | | | | |
Collapse
|
24
|
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.
Collapse
Affiliation(s)
- N Reyns
- Department of Neurosurgery, University of Lille, France
| | | | | | | |
Collapse
|
25
|
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.
Collapse
Affiliation(s)
- R Greiner-Perth
- Department of Neurosurgery, Zentralklinik Bad Berka GmbH, Federal Republik of Germany
| | | | | |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
- D V Loesch
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
27
|
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]
|
28
|
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.
Collapse
Affiliation(s)
- Y Katayama
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | |
Collapse
|