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Dulamea AO, Lupescu IC. Cerebral cavernous malformations - An overview on genetics, clinical aspects and therapeutic strategies. J Neurol Sci 2024; 461:123044. [PMID: 38749279 DOI: 10.1016/j.jns.2024.123044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024]
Abstract
Cerebral cavernous malformations (CCMs) are abnormally packed blood vessels lined with endothelial cells, that do not exhibit intervening tight junctions, lack muscular and elastic layers and are usually surrounded by hemosiderin and gliosis. CCMs may be sporadic or familial autosomal dominant (FCCMs) caused by loss of function mutations in CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10) genes. In the FCCMs, patients have multiple CCMs, different family members are affected, and developmental venous anomalies are absent. CCMs may be asymptomatic or may manifest with focal neurological deficits with or without associated hemorrhage andseizures. Recent studies identify a digenic "triple-hit" mechanism involving the aquisition of three distinct genetic mutations that culminate in phosphatidylinositol-3-kinase (PIK3CA) gain of function, as the basis for rapidly growing and clinically symptomatic CCMs. The pathophysiology of CCMs involves signaling aberrations in the neurovascular unit, including proliferative dysangiogenesis, blood-brain barrier hyperpermeability, inflammation and immune mediated processes, anticoagulant vascular domain, and gut microbiome-driven mechanisms. Clinical trials are investigating potential therapies, magnetic resonance imaging and plasma biomarkers for hemorrhage and CCMs-related epilepsy, as well as different techniques of neuronavigation and neurosonology to guide surgery in order to minimize post-operatory morbidity and mortality. This review addresses the recent data about the natural history, genetics, neuroimaging and therapeutic approaches for CCMs.
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Affiliation(s)
- Adriana Octaviana Dulamea
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania.
| | - Ioan Cristian Lupescu
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania
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Ziegenfuß C, van Landeghem N, Meier C, Pförtner R, Eckstein A, Dammann P, Haubold P, Haubold J, Forsting M, Deuschl C, Wanke I, Li Y. MR Imaging Characteristics of Solitary Fibrous Tumors of the Orbit : Case Series of 18 Patients. Clin Neuroradiol 2024:10.1007/s00062-024-01400-8. [PMID: 38456912 DOI: 10.1007/s00062-024-01400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Solitary fibrous tumor (SFT) of the orbit is a rare tumor that was first described in 1994. We aimed to investigate its imaging characteristics that may facilitate the differential diagnosis between SFT and other types of orbital tumors. MATERIAL AND METHODS Magnetic resonance imaging (MRI) data of patients with immunohistochemically confirmed orbital SFT from 2002 to 2022 at a tertiary care center were retrospectively analyzed. Tumor location, size, morphological characteristics, and contrast enhancement features were evaluated. RESULTS Of the 18 eligible patients 10 were female (56%) with a mean age of 52 years. Most of the SFTs were oval-shaped (67%) with a sharp margin (83%). The most frequent locations were the laterocranial quadrant (44%), the extraconal space (67%) and the dorsal half of the orbit (67%). A flow void phenomenon was observed in nearly all cases (94%). On the T1-weighted imaging, tumor signal intensity (SI) was significantly lower than that of the retrobulbar fat and appeared predominantly equivalent (82%) to the temporomesial brain cortex, while on T2-weighted imaging its SI remained equivalent (50%) or slightly hyperintense to that of brain cortex. More than half of the lesions showed a homogeneous contrast enhancement pattern with a median SI increase of 2.2-fold compared to baseline precontrast imaging. CONCLUSION The SFT represents a rare orbital tumor with several characteristic imaging features. It was mostly oval-shaped with a sharp margin and frequently localized in the extraconal space and dorsal half of the orbit. Flow voids indicating hypervascularization were the most common findings.
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Affiliation(s)
- Christoph Ziegenfuß
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Natalie van Landeghem
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Chiara Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Essen, Kliniken-Essen-Mitte, Henricistraße 92, 45136, Essen, Germany
| | - Roman Pförtner
- Department of Oral and Maxillofacial Surgery, University Hospital Essen, Kliniken-Essen-Mitte, Henricistraße 92, 45136, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Patrizia Haubold
- Department of Diagnostic and Interventional Radiology, Kliniken Essen-Mitte, Henricistraße 92, 45136, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- Swiss Neuroradiology Institute, Bürglistraße 29, 8002, Zürich, Switzerland
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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Adhikari P, Nepali A, Shah A, Paudel S, Bhandari P, Nepali P. A small frontal lobe cavernoma presenting with headache mimicking migraine and complex focal seizure: A case report. Clin Case Rep 2024; 12:e8472. [PMID: 38323134 PMCID: PMC10844583 DOI: 10.1002/ccr3.8472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024] Open
Abstract
Cavernoma, or cerebral cavernous angioma, are hamartomatous lesions formed by sinusoidal vascular spaces without cerebral parenchyma in between. Cavernoma is a rare disorder that is diagnosed infrequently and incidentally, so it is called incidentaloma. However, cavernoma can present with seizures, headaches, and other focal neurological deficits, with seizures being the most frequent presentation. Cavernoma is angiographically concealed, and it's diagnosis is challenging. So, the cavernoma is diagnosed based on an MRI. We present the rare case of a patient who presented with a complex focal seizure and migraine-like headache caused by a small frontal lobe cavernoma.
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Affiliation(s)
| | - Anil Nepali
- Kathmandu University School of Medical SciencesPanautiNepal
- Patan Academy of Health SciencesLalitpurNepal
| | - Amit Shah
- Patan Academy of Health SciencesLalitpurNepal
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Al Sada F, Khan MM, Iqbal J, Mohammed K, Ayyad A. Subarachnoid Hemorrhage Caused by Supratentorial Cerebral Cavernous Malformation: A Case Report. Cureus 2024; 16:e51597. [PMID: 38313963 PMCID: PMC10836757 DOI: 10.7759/cureus.51597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Cavernous malformations (CMs) are acquired vascular abnormalities of the central nervous system that are typically asymptomatic. Clinically symptomatic lesions may present with seizures, intracerebral hemorrhage, or focal neurological deficits. Very rarely, CMs have been described as the cause of subarachnoid hemorrhage. We report a case of a previously healthy 58-year-old man who presented with acute onset of severe headache associated with vomiting. Head computed tomography (CT) scan showed subarachnoid hemorrhage with intraventricular extension. Subsequent CT angiography (CTA) and digital subtraction angiography (DSA) studies showed no evidence of vascular abnormalities. The patient was initially managed conservatively but later required neurosurgical and radiological interventions due to a complicated hospital course and worsening clinical condition. During surgery, an incidental mass was found in the temporal lobe, and subsequent histopathological examination confirmed the diagnosis of cavernoma, which was likely the underlying cause of the subarachnoid hemorrhage. This report highlights the importance of considering CMs in the differential diagnoses of subarachnoid hemorrhage, especially in the absence of informative results from CTA and DSA studies. Timely detection and management of CMs may positively impact the clinical outcome, leading to reduced morbidity and mortality rates.
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Affiliation(s)
| | | | - Javeed Iqbal
- Neurosurgery, Hamad Medical Corporation, Doha, QAT
| | | | - Ali Ayyad
- Neurosurgery, Hamad Medical Corporation, Doha, QAT
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Harty M, Baqai MWS, Sajjad J, Fellows G, Clamp PJ, Abhinav K. Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve. Front Surg 2023; 10:1278177. [PMID: 38186386 PMCID: PMC10771842 DOI: 10.3389/fsurg.2023.1278177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Most cavernous malformations (CM) usually involve the parenchyma and rarely occur in cranial nerves. Recurrence of CM associated with cranial nerves after surgical resection has not been previously reported. Case description This paper describes the case of an 11-year-old girl who presented with left otalgia and headache because of a left trigeminal cavernous malformation. She underwent radical resection via a left retrosigmoid approach while sparing the trigeminal nerve. Surveillance imaging at 18 months demonstrated recurrence along the length of the trigeminal nerve into Meckel's cave with significant extension into the middle cerebellar peduncle. Subsequent re-operation via an extended middle fossa approach with anterior petrosectomy enabled complete resection with division of the trigeminal nerve. Postoperatively, she had a transient left facial paresis, and right hemiparesis that resolved within 48 h. Conclusion This case highlights the importance of close postoperative surveillance in CM associated with cranial nerves as recurrence after nerve-sparing resection is possible. Surgical treatment due to the morphology of significant recurrence required the use of a complex skull base approach through a new corridor to achieve optimal clinical outcome.
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Affiliation(s)
- Mikhail Harty
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Jahangir Sajjad
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Greg Fellows
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, University Hospitals NHS Trust, Bristol, United Kingdom
| | - Philip J Clamp
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, University Hospitals NHS Trust, Bristol, United Kingdom
| | - Kumar Abhinav
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Xu S, Yang L. Diagnosis and treatment status of suprasellar optic pathway cavernous malformations. J Int Med Res 2023; 51:3000605231219167. [PMID: 38147640 PMCID: PMC10752090 DOI: 10.1177/03000605231219167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023] Open
Abstract
Cerebral cavernous malformations constitute a subtype of cerebral vascular malformation typically located in the cerebral cortex. However, their occurrence in the suprasellar optic pathway is relatively rare. There is some uncertainty surrounding the clinical diagnostic methods and optimal treatment strategies specific to suprasellar optic pathway cavernous malformations. In this narrative review, we retrospectively analyzed relevant literature related to suprasellar visual pathway cavernous malformations. We conducted a study involving 90 patients who were postoperatively diagnosed with cavernous malformations, including the 16-year-old male patient mentioned in this article. We have summarized crucial clinical data, including the patient age distribution, sex ratio, lesion locations, primary symptoms, and surgical approaches. The comprehensive analysis of this clinical information underscores the critical importance of timely intervention in relieving symptoms and improving neurological deficits in affected patients. These findings provide valuable guidance and insight for clinical practitioners and researchers dealing with this specific medical condition.
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Affiliation(s)
- Songbai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Liu Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Ikramuddin S, Liu S, Ryan D, Hassani S, Hasan D, Feng W. Propranolol or Beta-Blockers for Cerebral Cavernous Malformation: a Systematic Review and Meta-analysis of Literature in Both Preclinical and Clinical Studies. Transl Stroke Res 2023:10.1007/s12975-023-01199-5. [PMID: 37857790 DOI: 10.1007/s12975-023-01199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Cerebral cavernous malformation (CCM), either sporadic or familial, is a devastating vascular malformation affecting the central nervous system that can present with intracerebral hemorrhage, seizure, and new focal neurologic deficits resulting in substantial morbidity and mortality. To date, there is no effective evidence-based preventive regimen. There have been several preclinical and clinical studies investigating the potential mechanisms and benefits of beta-blockers, especially on propranolol. We aimed to conduct a systematic review on the published literature investigating the use of beta-blockers in the treatment of CCM, including both preclinical and clinical studies between 2008 and 2023 using public databases. A total of 2 preclinical studies and 6 clinical studies met the inclusion/exclusion criteria and were included. Data was extracted and synthesized from 5 clinical studies for meta-analysis. The meta-analysis failed to demonstrate a statistically significant protective effect of beta-blockers in preventing intracerebral hemorrhage or developing focal neurologic deficits in subjects with CCM (overall effect = 0.78 (0.20, 3.11), p = 0.73). Overall, there was a paucity of high quality clinical trials, partially due to limited cases of CCM. Addressing this gap may require collaborative efforts at a national or international level. In this review, we summarized all barriers and opportunities on this topic. Additionally, we proposed establishing an evidence-based approach on the use of beta-blockers in preventing recurrent hemorrhage and focal neurological deficits in patients with CCM.
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Affiliation(s)
- Salman Ikramuddin
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Shimeng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dylan Ryan
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Sara Hassani
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - David Hasan
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
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Bani-Sadr A, Eker OF, Cho TH, Ameli R, Berhouma M, Cappucci M, Derex L, Mechtouff L, Meyronet D, Nighoghossian N, Berthezène Y, Hermier M. Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas. AJNR Am J Neuroradiol 2023; 44:807-813. [PMID: 37385679 PMCID: PMC10337618 DOI: 10.3174/ajnr.a7914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. MATERIALS AND METHODS Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample. RESULTS Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (P < .001), regular margins (P = .009), absence of extralesional hemorrhage (P = .01), and absence of peripheral rim enhancement (P = .002). These criteria were included in the decision tree model. The validation sample (n = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%). CONCLUSIONS An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.
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Affiliation(s)
- A Bani-Sadr
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - O F Eker
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - T-H Cho
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - R Ameli
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | - M Berhouma
- Skull Base Surgery Unit (M.B.), Department of Neurosurgery B
| | - M Cappucci
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | - L Derex
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- Research on Healthcare Performance (L.D.), Institut National de la Santé et de la Recherche Médicale U 1290, Claude Bernard Lyon I University, Domaine Rockefeller, Lyon, France
| | - L Mechtouff
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - D Meyronet
- Institute of Pathology East, Neuropathology (D.M.), East Group Hospital, Hospices Civils de Lyon, Bron, France
| | - N Nighoghossian
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - Y Berthezène
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - M Hermier
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
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Graffeo CS, Scherschinski L, Benner D, Devia DA, Thomas G, Koester SW, Catapano JS, Winkler EA, Srinivasan VM, Lawton MT. Approach Selection Strategies for Repeat Resection of Brain Cavernous Malformations: Cohort Study. Oper Neurosurg (Hagerstown) 2023; 24:590-601. [PMID: 36867084 DOI: 10.1227/ons.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/19/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Neurosurgical management of cerebral cavernous malformations (CMs) often benefits from using skull base approaches. Although many CMs are cured by resection, residual or recurrent disease may require repeat resection. OBJECTIVE To review approach selection strategies for reoperation of CMs to aid decision-making for repeat procedures. METHODS In this retrospective cohort study, a prospectively maintained single-surgeon registry was queried for patients with CMs who underwent repeat resection from January 1, 1997, to April 30, 2021. RESULTS Of 854 consecutive patients, 68 (8%) underwent 2 operations; 40 had accessible data on both. In most reoperations (33/40 [83%]), the index approach was repeated. In most reoperations using the index approach (29/33 [88%]), that approach was deemed ideal (no equivalent or superior alternative), whereas in some (4/33 [12%]), the alternative approach was deemed unsafe because of conformation of the tract. Among patients with reoperations using an alternative approach (7/40 [18%]), 2 with index transsylvian approaches underwent bifrontal transcallosal approaches, 2 with index presigmoid approaches underwent extended retrosigmoid revisions, and 3 with index supracerebellar-infratentorial approaches underwent alternative supracerebellar-infratentorial trajectory revisions. Among patients with reoperations with an alternative approach considered or selected (11/40 [28%]), 8 of 11 patients had a different surgeon for the index resection than for the repeat resection. The extended retrosigmoid-based approaches were used most often for reoperations. CONCLUSION Repeat resection of recurrent or residual CMs is a challenging neurosurgical niche at the intersection of cerebrovascular and skull base disciplines. Suboptimal index approaches may limit surgical options for repeat resection.
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Affiliation(s)
- Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Okwudire-Ejeh I, Ezike KN, Mandong BM, Dauda AM, Binitie PO, Shilong D, Akpa PO. Demographic and Diagnostic Spectrum of Neurosurgical Biopsies: Initial Experience From a Re-established Neurosurgical Unit in a Tertiary Hospital in North Central Nigeria. Cureus 2023; 15:e35238. [PMID: 36968921 PMCID: PMC10033700 DOI: 10.7759/cureus.35238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Neurosurgical biopsies are obtained from lesions of the central nervous system, comprising the skull, brain, spine, spinal cord, and nerves. Neurosurgery practice is a highly specialized field with wide disparities related to access to care, especially in developing countries where there are few specialists and poor support care for patients. After over 20 years of redundancy, the neurosurgical unit in Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria, was re-established to meet the needs of patients in the area of neurosurgery. The aim of the study is to document the demographic and diagnostic spectrum of neurosurgical biopsies obtained in JUTH in the first five years of the re-establishment of its neurosurgical unit, highlighting the need for inclusion of neurosurgical services in health planning and resource allocation; and to compare these findings to similar studies elsewhere. Materials and methods This was a retrospective, descriptive, hospital-based study of neurosurgical lesions diagnosed in the Department of Histopathology at JUTH between January 2011 and December 2015. One hundred and forty-five lesions met the inclusion criteria out of 151 in the records and were studied. Archival slides of these neurosurgical biopsies were retrieved, and fresh sections were re-cut and stained with hematoxylin and eosin (H&E) where necessary. The diagnoses of some of the neoplastic lesions were confirmed by immunohistochemistry. The data obtained was analyzed, and the results are presented as tables, bar charts, ratios, and percentages. Results Thirty-one different lesions were diagnosed. The lesions most commonly diagnosed were traumatic/degenerative intervertebral disc, 54/145 (37.2%); neoplastic, 48/145 (33.1%); and congenital, 31/145 (21.4%), while inflammatory/infectious, 9/145 (6.2%); and vascular, 3 (2.0%) lesions were the least. Bimodal peak frequencies involving the 0-14 years and 30-44 years age ranges were noted for the neoplastic lesions, occurring 37.5% (18/48) in the 0-14 years and 25% (12/48) in the 30-44 years, respectively. The 31 congenital anomalies diagnosed were all neural tube defects, and of these, occipital encephalocele, 10/31 (32.3%) and myelomeningocele, 9/31 (29.0%) were diagnosed most frequently. Of the neoplastic lesions, 66.7% (32/48) were benign and low-grade, and 33.3% (16) were malignant. Meningioma, 14/32 (43.8%), was the most common benign and low-grade neoplasm and accounted for 29.1% (14/48) of all neoplastic lesions. Astrocytoma (WHO grades I, II), 25% (8/32), was the next most common benign and low-grade neoplasm and accounted for 16.7% (8/48) overall. Astrocytoma (WHO grades III, IV), 8/16 (50%), was the most common malignant neoplasm and accounted for 16.7% (8/48) overall. Overall, neuroepithelial tumors, both benign and low-grade, and malignant, 43.8% (21/48), were the commonest neoplastic lesions. Most neoplastic lesions occurred in the brain, 75% (32/48), followed by the spine, 10.4% (5/48), and skull, 8.3% (4/48); while the least common was the spinal cord, 2.1% (1/48). The sex distribution of the neoplastic lesions showed almost equal frequency between males and females, 23/48 (47.9%) and 25/48 (52.1%). Conclusion The spectrum of neurological lesions highlighted in this study demonstrates that neurosurgical lesions abound in our environment with a similar prevalence to other regions of the world, and therefore speaks to the need for neurosurgical services.
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Gillespie CS, Alnaham KE, Richardson GE, Mustafa MA, Taweel BA, Islim AI, Hannan CJ, Chavredakis E. Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study. Neurosurg Rev 2023; 46:52. [PMID: 36763222 PMCID: PMC9918566 DOI: 10.1007/s10143-023-01949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify variables associated with haemorrhage, and calculate haemorrhage risk in CCM. We conducted a retrospective study of patients diagnosed with a CCM, managed at a specialist tertiary neuroscience centre (2007-2019). The primary outcome was symptomatic haemorrhage, and secondary outcomes were variables associated with increased risk of haemorrhage, using multivariable Cox regression analysis. Included were 545 patients, with 734 confirmed cavernomas. Median age at diagnosis was 47 (interquartile range [IQR] 35-60), with a median follow-up duration after diagnosis of 46 months (IQR 19-85). Of the patients, 15.0% had multiple lesions (N = 82/545). Symptomatic presentation was observed in 52.5% of patients (N = 286/545). The annual haemorrhage rate was 1.00% per lesion-year (25 events in 2512 lesion-years), and higher in those with symptoms at presentation (1.50% per lesion-year, 22 events vs 0.29%, 3 events, P < 0.001). The variables associated with symptomatic haemorrhage were increased size (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01-1.07, P = 0.004), eloquent location (HR 2.63, 95% CI 1.12-6.16, P = 0.026), and symptomatic haemorrhage at presentation (HR 5.37, 95% CI 2.40-11.99, P < 0.001). This study demonstrated that CCMs have a low haemorrhage rate. Increased size, eloquent location, and haemorrhage at presentation appear to be predictive of a higher risk of haemorrhage, and could be used to stratify management protocols.
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Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | | | - George E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Basel A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Cathal John Hannan
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Academic Health Science Centre, University of Manchester, Manchester, UK
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12
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Xiu C, Ni D, Zhao J, Yu Y. Analysis of characteristics of intracranial cavernous angioma and bleeding factors in middle-aged and elderly patients. Front Neurol 2023; 14:1084911. [PMID: 36815003 PMCID: PMC9939627 DOI: 10.3389/fneur.2023.1084911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023] Open
Abstract
Objective Intracranial cavernous angioma (ICA) is a cerebrovascular malformation. It causes local neurological dysfunction, epilepsy, intracranial hemorrhage (ICH) and other symptoms, seriously affecting the safety of patients. This study analyzed middle-aged and elderly patients with ICA in our hospital, summarized the characteristics of the disease and investigated the related factors of ICH. Methods We conducted a retrospective analysis of 120 middle-aged and elderly patients who were diagnosed with ICA by magnetic resonance imaging in our hospital from March 2018 to September 2021. The cases were assigned to either a bleeding group (i.e., the experimental group) or a non-bleeding group (i.e., the control group). The characteristics of the disease, including gender, age, number of lesions, form and symptoms of onset, distribution of lesions, blood supply vessels in the lesion area, size of the lesion and presence of bleeding, were summarized and analyzed. The relationship between these factors and ICH was investigated, and the data were analyzed using SPSS 25.0 software. Results There were 56 cases in the experimental group and 64 cases in the control group. A univariate analysis showed that gender, age, body mass index, blood lipids, number of lesions, course of the disease, onset of symptoms and disease characteristics were not associated with ICH in the middle-aged and elderly patients with ICA (P > 0.05). The maximum diameter, volume, location and blood supply area of the lesions were related to ICA complicated with ICH (P < 0.05). A multivariate unconditional logistic regression analysis revealed that the maximum diameter, volume, location and blood supply area of the lesions were independent risk factors for ICH in the middle-aged and elderly patients with ICA. The odds ratio (OR) of the maximum diameter of the lesion was 4.410, the OR of the lesion volume was 7.316, the OR of the lesion site was 7.470, and the OR of the blood supply area was 1.6588. Conclusion Intracranial cavernous angioma lesions in middle-aged and elderly patients occur mainly in the supratentorial area, with a small part located in the infratentorial area. The main form of the disease is chronic recurrence. The occurrence of bleeding is related to the size, location and blood supply of the lesion.
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Affiliation(s)
- Chao Xiu
- Medical Imaging Center, Affiliated Hospital of Beihua University, Jilin City, China
| | - Donghe Ni
- Nuclear Magnetic Resonance Department, Integrated Traditional Chinese and Western Medicine Hospital of Jilin Province, Jilin City, China
| | - Jincui Zhao
- Medical Imaging Center, Affiliated Hospital of Beihua University, Jilin City, China
| | - Yang Yu
- Medical Imaging Center, Affiliated Hospital of Beihua University, Jilin City, China
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13
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Bauman MMJ, Patra DP, Bendok BR. Commentary: Transcallosal Transchoroidal Approach to the Third Ventricle for Resection of a Thalamic Cavernoma-Anatomical Landmarks Review: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e211-e213. [PMID: 35972121 DOI: 10.1227/ons.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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14
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Chung MW, Chuang CC, Wang CC, Chen HC, Hsu PW. Prognostic Factors Analysis for Intracranial Cavernous Malformations Treated with Linear Accelerator Stereotactic Radiosurgery. Life (Basel) 2022; 12:life12091363. [PMID: 36143399 PMCID: PMC9505264 DOI: 10.3390/life12091363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is generally considered a substitute for cranial cavernous malformations (CCMs). However, prognostic factors for post-radiosurgery CCM rebleeding and adverse radiation effects have not been well evaluated, and the effect of timing and optimal treatment remains controversial. Therefore, this study evaluated prognostic factors for post-radiosurgical rebleeding and focal edematous changes in 30 patients who developed symptomatic intracranial hemorrhage due to solitary non-brainstem CCM and received linear accelerator (LINAC) SRS in a single medical center from October 2002 to June 2018. An overall post-radiosurgical annual hemorrhage rate with 4.5% was determined in this study. In addition, a higher marginal dose of >1600 centigray and earlier LINAC SRS intervention were correlated with a significantly lower post-radiosurgical annual hemorrhage rate. A lesion size larger than 3 cm3 and a coexisting developmental venous anomaly were significant risk factors for post-radiosurgical focal brain edema but mostly resulted in no symptoms and were temporary. This study demonstrated the efficacy of LINAC SRS in preventing CCM rebleeding and suggests that earlier radiosurgery treatment with a higher dose for non-brainstem symptomatic CCMs be considered.
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Affiliation(s)
- Meng-Wu Chung
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence:
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15
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Kumar S, Singh P, Singh SP, Kumar M. Unusual case of g iant cerebral infiltrative cavernoma causing obstructive hydrocephalus. BMJ Case Rep 2022; 15:e249691. [PMID: 35606026 PMCID: PMC9125702 DOI: 10.1136/bcr-2022-249691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sunil Kumar
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priya Singh
- Radiodiagnosis, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
- Radiodiagnosis, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Surya Pratap Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manish Kumar
- Radiodiagnosis, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
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16
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Levetiracetam-Induced Psychosis in the Setting of Intracranial Cavernomas. Case Rep Psychiatry 2022; 2022:9114118. [PMID: 35356150 PMCID: PMC8960016 DOI: 10.1155/2022/9114118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/26/2022] [Accepted: 03/04/2022] [Indexed: 01/17/2023] Open
Abstract
Levetiracetam is a commonly used antiepileptic medication that has been associated with the development of psychosis. Cavernomas are vascular malformations that have been associated with psychosis as well, especially in the setting of hemorrhagic transformation. This case report describes a patient with cavernomas who developed psychotic symptoms after restarting her levetiracetam at a high dose (2000 mg twice a day) without gradual uptitration. Her symptoms improved upon the reduction of the levetiracetam as well as the initiation of paliperidone. This case highlights the importance of considering the biologic and medication-related factors for the development of psychosis, as well as the importance of gradual medication adjustments.
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17
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Ganz JC. Cavernous malformations. PROGRESS IN BRAIN RESEARCH 2022; 268:115-132. [PMID: 35074077 DOI: 10.1016/bs.pbr.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cavernous malformations are relatively common intracerebral malformations of which we only became properly aware after the introduction of MRI. They may be sporadic or familial. Familial CMs may be multiple and new lesions appear over time requiring intermittent MR control. Many sporadic CMs have no symptoms. The commonest location is in the supratentorial cerebral parenchyma presenting with epilepsy. The best treatment is microsurgery. A small proportion are in the brainstem and may rebleed and even be lethal. Treatment includes microsurgery and radiosurgery. Microsurgery cures the patient but has substantial problems with complications, deterioration and partial removal. Radiosurgery has taken time to demonstrate that it can over 2 years substantially reduce the risk of rebleeds without the risks of microsurgery. Both methods have a part to play in the treatment.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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18
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Miyata H, Kuwashige H, Hori T, Kubota Y, Pieper T, Coras R, Blümcke I, Yoshida Y. Variable histopathology features of neuronal dyslamination in the cerebral neocortex adjacent to epilepsy-associated vascular malformations suggest complex pathogenesis of focal cortical dysplasia ILAE type IIIc. Brain Pathol 2022; 32:e13052. [PMID: 35001442 PMCID: PMC9425012 DOI: 10.1111/bpa.13052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/14/2023] Open
Abstract
Focal cortical dysplasia type IIIc (FCD‐IIIc) is histopathologically defined by the International League Against Epilepsy's classification scheme as abnormal cortical organization adjacent to epilepsy‐associated vascular malformations (VM). However, the incidence of FCD‐IIIc, its pathogenesis, or association with the epileptogenic condition remains to be clarified. We reviewed a retrospective series of surgical brain specimens from 14 epilepsy patients with leptomeningeal angiomatosis of Sturge‐Weber syndrome (LMA‐SWS; n = 6), cerebral cavernous malformations (CCM; n = 7), and an arteriovenous malformation (AVM; n = 1) to assess the histopathological spectrum of FCD‐IIIc patterns in VM. FCD‐IIIc was observed in all cases of LMA‐SWS and was designated as cortical pseudolaminar sclerosis (CPLS). CPLS showed a common pattern of horizontally organized layer abnormalities, including neuronal cell loss and astrogliosis, either manifesting predominantly in cortical layer (L) 3 extending variably to deeper areas with or without further extension to L2 and/or L4. Another pattern was more localized, targeting mainly L4 with extension to L3 and/or L5. Abnormal cortical layering characterized by a fusion of L2 and L3 or L4–L6 was also noted in two LMA‐SWS cases and the AVM case. No horizontal or vertical lamination abnormalities were observed in the specimens adjacent to the CCM, despite the presence of vascular congestion and dilated parenchymal veins in all VM. These findings suggest that FCD‐IIIc depends on the type of the VM and developmental timing. We further conclude that FCD‐IIIc represents a secondary lesion acquired during pre‐ and/or perinatal development rather than following a pathomechanism independent of LMA‐SWS. Further studies will be necessary to address the selective vulnerability of the developing cerebral neocortex in LMA‐SWS, including genetic, encephaloclastic, hemodynamic, or metabolic events.
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Affiliation(s)
- Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Haruka Kuwashige
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Tomokatsu Hori
- Department of Neurosurgery, Medical Corporation Moriyamakai, Moriyama Neurological Center Hospital, Tokyo, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan.,Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany
| | - Yasuji Yoshida
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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19
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Thompson D, Zammit A, Yuen J, Hand C, Likeman M, Singleton W, Nelson R, Fellows G. Paediatric Cavernous Malformation of the Trigeminal Nerve: Case Report and Review of the Literature. Pediatr Neurosurg 2022; 57:207-212. [PMID: 35398849 DOI: 10.1159/000524522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intradural, extra-axial cerebral cavernous malformations (CCMs) are rare entities and are mostly reported in relation to the optic apparatus or the facial/vestibulocochlear complex. Cranial nerve CCMs tend to follow a clinically aggressive course, with a tendency to progressive neurological dysfunction following intra-lesional haemorrhage or less commonly due to the effects of subarachnoid haemorrhage. CASE PRESENTATION We report the first case of a trigeminal CCM presenting in a child with otalgia and left-sided headaches. The patient was initially managed with radiological surveillance but required surgical management following deterioration. We describe the successful treatment of the lesion with microsurgical resection. CONCLUSION A CCM should be considered in the differential diagnosis of mass lesions arising in the region of the trigeminal nerve. Surgical resection is recommended to prevent neurological deterioration and may result in significant symptomatic improvement.
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Affiliation(s)
- Daniel Thompson
- Department of Neurosurgery, Bristol Children's Hospital, Bristol, United Kingdom
| | - Adrian Zammit
- Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom
| | - Jason Yuen
- Department of Neurosurgery, Bristol Children's Hospital, Bristol, United Kingdom
| | - Charles Hand
- Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom
| | - Marcus Likeman
- Department of Radiology, Bristol Children's Hospital, Bristol, United Kingdom
| | - William Singleton
- Department of Neurosurgery, Bristol Children's Hospital, Bristol, United Kingdom
| | - Richard Nelson
- Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom
| | - Greg Fellows
- Department of Neurosurgery, Bristol Children's Hospital, Bristol, United Kingdom
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20
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Gilbert OE, Wilson JM, Volk JM. Giant Frontotemporal Cavernous Malformation in a 2-Month-Old Infant: A Case Report and Review of the Literature. Pediatr Neurosurg 2022; 57:56-62. [PMID: 34749375 DOI: 10.1159/000519856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cavernous malformations in the pediatric population are exceedingly rare, especially in infants. Giant cavernous malformations (GCM) are even more rare and have a diameter >4 cm. The onset of symptoms predominantly occurs in adulthood, but the rate of hemorrhage is significantly higher in the pediatric population. Similar to non-GCM, GCM can be misidentified as tumors on imaging due to their tumefactive pattern with edema. Here, we present a rare case of a right frontotemporal GCM in a 2-month-old girl, the youngest recorded case in the existing literature. CASE PRESENTATION A previously healthy 2-month-old girl presented to the emergency department following an increasing frequency of seizure-like activity that began 3 days prior to presentation. Magnetic resonance imaging of the brain with and without contrast characterized a large (5.8 × 4.3 × 4.2 cm) heterogeneous lesion of the right temporal lobe with diffuse scattered blood products of various ages seen throughout the lesion. She underwent a right-sided craniotomy where a gross total excision was achieved. Pathology confirmed the diagnoses of a GCM. The patient's seizures subsequently resolved, and she continues to do well postoperatively. DISCUSSION/CONCLUSION GCM can be mistaken for tumors due to their large size, cystic nature, and surrounding edema, but a vascular lesion should always remain in the differential diagnosis before operating, even in infants. Surgery is generally recommended in patients that present with a symptomatic hemorrhage, recurrent hemorrhages, persistent seizures despite medical management, or progressively worsening neurological deficits if the GCM is in a safe location. It has been shown that 70-99% of patients undergoing surgery with successful removal of the GCM can achieve seizure freedom 2 years postoperatively. Complete surgical excision of this infant's GCM was successful in treating her neurologic symptoms; therefore, pathological confirmation of this lesion is critical and should prompt a complete surgical excision.
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Affiliation(s)
- Olivia E Gilbert
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA,
| | - John M Wilson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jerome M Volk
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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21
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Patel M, Mahajan U, Pace J, Rothstein B. Presentation and management of nervous system cavernous malformations in children: A systematic review and case report. Brain Circ 2022; 8:121-126. [PMID: 36267435 PMCID: PMC9578313 DOI: 10.4103/bc.bc_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. Here, we conduct a literature review and then present a report of a supratentorial CM in a 2-year-old patient with no significant past medical history who presented at our institution with 1 month of eye twitching. We performed a literature search of five databases of all articles published before 2020. Our inclusion criteria included cohort and case series of children with mean age under 12 years. Our search yielded 497 unique articles, of which 16 met our inclusion criteria. In our pooled literature analysis, a total of 558 children were included, 8.3% of which had a positive family history and 15.9% had multiple CMs. About 46.1% of the children had seizures, and 88.4% of those who underwent surgery had a total resection. About 85.1% of those with epilepsy were Engel Class 1 postsurgery. Over a mean follow-up of 4.1 years, 3.4% of patients had additional neurological deficits, including paresis and speech deficits. Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. Additional work is needed on outcomes and long-term effects of minimally invasive treatments, including radiosurgery and laser ablation, in pediatric populations.
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22
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Surgical Management of Cavernous Malformations and Venous Anomalies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00075-2] [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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23
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A series of 14 representative presentations of cerebral cavernous malformations. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Zattra CM, Restelli F, Broggi M. Commentary: Endoscopic Endonasal Excision of an Optic Pathway Cavernous Malformation: Technical Case Report. Oper Neurosurg (Hagerstown) 2021; 21:E163-E164. [PMID: 34015827 DOI: 10.1093/ons/opab166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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25
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Navigation-Guided Nasal Endoscopy to Remove the Cavernous Venous Malformation of the Orbital Apex Through the Sphenoid Approach. J Craniofac Surg 2021; 32:1765-1769. [PMID: 34319680 DOI: 10.1097/scs.0000000000007346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore the feasibility of navigation-guided sinus endoscopy to remove the cavernous vascular malformation of the orbital apex through the sphenoid approach. METHODS A retrospective series of non-control cases were collected. From May 2012 to December 2019, patients with imaging findings of cavernous venous malformation in the orbital apex were collected at the Eye Hospital Affiliated to Nanchang University. All patients underwent navigation guided sinusoscopy through the sphenoid approach to remove the cavernous venous malformation of the orbital apex. Analyze the changes of visual function and postoperative complications before and after operation. RESULTS Twelve patients were collected, including 3 males and 9 females aged between 32 and 59. In 3 patients without visual impairment, the postoperative visual function was still normal. The remaining 9 patients all had visual impairment. Among them, 3 patients had fully recovered normal visual function after operation, 2 patients had improved visual function compared with preoperative, and 4 patients had no change in postoperative visual acuity. There were no complications in 3 of the 12 patients, and 9 patients had transient limited intraocular rotation with mild limitation of diplopia after operation, and all returned to normal within 1 month after surgery. CONCLUSION Navigation-guided sinus endoscopy through the sphenoid approach to remove the cavernous venous malformation of the orbital apex is an effective and feasible surgical method.
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26
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Shoubash L, Baldauf J, Matthes M, Kirsch M, Rath M, Felbor U, Schroeder HWS. Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas. Neurosurg Rev 2021; 45:649-660. [PMID: 34164745 PMCID: PMC8827309 DOI: 10.1007/s10143-021-01572-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/18/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study is to analyze the long-term quality of life after surgery of cavernoma. A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12). Forty-one lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit, and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. Regarding QoL assessment of 44 patients (EG n = 27, NEG n = 14) attended the last follow-up. Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles. At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. These results add value for decision-making as well as patient counseling for future encountered cases. Preoperative evaluation of QoL is recommended for future studies to assess QoL dynamics.
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Affiliation(s)
- Loay Shoubash
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
| | - Jörg Baldauf
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Marc Matthes
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Michael Kirsch
- Department of Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Rath
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
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Li W, Tran V, Shaked I, Xue B, Moore T, Lightle R, Kleinfeld D, Awad IA, Ginsberg MH. Abortive intussusceptive angiogenesis causes multi-cavernous vascular malformations. eLife 2021; 10:62155. [PMID: 34013885 PMCID: PMC8175082 DOI: 10.7554/elife.62155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
Mosaic inactivation of CCM2 in humans causes cerebral cavernous malformations (CCMs) containing adjacent dilated blood-filled multi-cavernous lesions. We used CRISPR-Cas9 mutagenesis to induce mosaic inactivation of zebrafish ccm2 resulting in a novel lethal multi-cavernous lesion in the embryonic caudal venous plexus (CVP) caused by obstruction of blood flow by intraluminal pillars. These pillars mimic those that mediate intussusceptive angiogenesis; however, in contrast to the normal process, the pillars failed to fuse to split the pre-existing vessel in two. Abortive intussusceptive angiogenesis stemmed from mosaic inactivation of ccm2 leading to patchy klf2a overexpression and resultant aberrant flow signaling. Surviving adult fish manifested histologically typical hemorrhagic CCM. Formation of mammalian CCM requires the flow-regulated transcription factor KLF2; fish CCM and the embryonic CVP lesion failed to form in klf2a null fish indicating a common pathogenesis with the mammalian lesion. These studies describe a zebrafish CCM model and establish a mechanism that can explain the formation of characteristic multi-cavernous lesions.
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Affiliation(s)
- Wenqing Li
- Department of Medicine, University of California, San Diego, La Jolla, United States
| | - Virginia Tran
- Department of Medicine, University of California, San Diego, La Jolla, United States
| | - Iftach Shaked
- Department of Physics, University of California, San Diego, La Jolla, United States
| | - Belinda Xue
- Department of Medicine, University of California, San Diego, La Jolla, United States
| | - Thomas Moore
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago School of Medicine and Biological Sciences, Chicago, United States
| | - Rhonda Lightle
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago School of Medicine and Biological Sciences, Chicago, United States
| | - David Kleinfeld
- Department of Physics, University of California, San Diego, La Jolla, United States.,Section of Neurobiology, University of California San Diego, La Jolla, United States
| | - Issam A Awad
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago School of Medicine and Biological Sciences, Chicago, United States
| | - Mark H Ginsberg
- Department of Medicine, University of California, San Diego, La Jolla, United States
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Al-Saiari S, Al-Orabi K, Farag A, Brinji Z, Azzouz A, Mohammed T, Mushtaq D, Hamouda W. Intrasellar cavernous hemangiomas: A case report with a comprehensive review of the literature. Surg Neurol Int 2021; 12:58. [PMID: 33654561 PMCID: PMC7911136 DOI: 10.25259/sni_622_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Extra-axial cerebral cavernous hemangiomas particularly those found in the sellar region, are extremely rare. Their clinical manifestations and imaging characteristics can mimic those of a pituitary adenoma thus making preoperative diagnosis difficult. Few cases are reported in the literature. We present a case, along with a comprehensive review of the literature regarding specific aspects of diagnosis and management of all similarly reported rare cases. Case Description: We present the clinical, radiological, and operative data of a rare case of a large intrasellar cavernous hemangioma in a 49-year-old female patient presented with headache and diminution of vision, which was diagnosed intraoperatively during an endonasal endoscopic transsphenoidal approach. Subtotal debulking was performed with immediate postoperative clinical improvement. The patient was then referred for radiotherapy and maintained her clinical improvement since then. Conclusion: Neurosurgeons should consider this rare pathology in the preoperative differential diagnosis of sellar tumors. Bright hyperintense T2 signal with or without signal voids associated with centripetal delayed contrast enhancement in magnetic resonance imaging images might raise the suspicion which can be further confirmed intraoperatively with frozen sections. Due the reported high vascularity and intraoperative profuse bleeding leading to high operative morbidities, piecemeal subtotal resection followed by radiosurgery may be considered today as the safest and most effective strategy.
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Affiliation(s)
- Sultan Al-Saiari
- Department of Neurosurgery, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Khalid Al-Orabi
- Department of Neurosurgery, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Ahmed Farag
- Department of Neurosurgery, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Zaina Brinji
- Department of Radiology, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Azza Azzouz
- Department of Radiology, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Tahira Mohammed
- Department of Pathology, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Deepa Mushtaq
- Department of Pathology, King Abdullah Medical City, Mecca, Western Province, Saudi Arabia
| | - Waeel Hamouda
- Department of Neurosurgery, Cairo University School of Medicine and Teaching Hospitals, Manial, Cairo, Egypt
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29
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Jagathesan T, OBrien M. Aeromedical Implications of Cerebral Cavernomas. Aerosp Med Hum Perform 2021; 92:120-123. [PMID: 33468293 DOI: 10.3357/amhp.5747.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Cavernomas, cavernous angiomas, or cerebral cavernous malformations are clusters of endothelium-lined blood vessels usually found in the brain. With the increasing use of radiological imaging, these are being detected incidentally in asymptomatic aircrew. The UK Civil Aviation Authority (CAA) experience of cavernomas is described and the aeromedical concerns, that is, the risk of epilepsy, hemorrhage, and the development of a neurological deficit, are considered.METHODS: A search of the CAA database between 1990 and 2020 was performed for the term cavernoma. The gender, age at diagnosis, class of certification held, clinical presentation, location, and size of the lesion were noted. A PubMed literature review for papers with complications of cavernoma was performed.RESULTS: Six cases of cavernoma have been declared to the CAA: five professional pilots and one private pilot. Five were men and one was a woman. The age range was between 38 and 60 yr, with a mean of 48 yr. Two cases presented with clinical symptoms and four were asymptomatic. Complication rates for seizure and hemorrhage were extracted from the published literature together with the significance of other factors such as cavernoma size, family history, multiplicity, and the development of new lesions.DISCUSSION: A policy for the medical certification of aircrew with cavernomas that have presented with clinical symptoms and those that are detected incidentally is proposed.Jagathesan T, OBrien M. Aeromedical implications of cerebral cavernomas. Aerosp Med Hum Perform. 2021; 92(2):120123.
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30
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Sabayan B, Lineback C, Viswanathan A, Leslie‐Mazwi TM, Shaibani A. Central nervous system vascular malformations: A clinical review. Ann Clin Transl Neurol 2021; 8:504-522. [PMID: 33434339 PMCID: PMC7886037 DOI: 10.1002/acn3.51277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022] Open
Abstract
CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. This range spans lesions with a risk of devastating neurological compromise to lesions with a slow, static or benign course. Advances in neurovascular imaging along with increased utilization of these advances, have resulted in more frequent identification of these lesions. In this article, we provide an overview on definitions and classifications of CNS vascular malformations and outline the etiologic, diagnostic, prognostic, and therapeutic features for each entity. This review covers intracranial and spinal cord vascular malformations and discusses syndromes associated with CNS vascular malformations.
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Affiliation(s)
- Behnam Sabayan
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Christina Lineback
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Anand Viswanathan
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Thabele M. Leslie‐Mazwi
- Departments of Neurosurgery and NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ali Shaibani
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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31
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Strickland BA, Brunswick A, Zada G. Exoscopic to Endoscopic Channel-Based Trans-Sulcal Resection of a Third Ventricular Cavernous Malformation: Technical Case Illustration. World Neurosurg 2021; 148:66. [PMID: 33453424 DOI: 10.1016/j.wneu.2021.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
Cavernous malformations are angiographically occult vascular hamartomas without intervening neural tissue that represent an estimated 10% of central nervous system vascular pathologies.1 Management is often dictated by lesion location, intranidal versus extranidal hemorrhage, presenting symptoms, acuity of onset, and surgical accessibility. Deep-seated cavernous malformations are often adjacent to eloquent structures, including functional white matter tracts that must be accounted for during surgical planning and respected during resection of the cavernoma. Exoscopic-guided channel-based approaches can help minimize retraction of brain tissue while providing a navigated, direct path to the target lesion.2 We report a case of an 18-year-old man who presented with seizures and was found to have a hemorrhagic third ventricular cavernous malformation resulting in hydrocephalus. A right frontal trans-sulcal approach using an exoscope and channel-based retractor was performed and directed along the long axis of the lesion to minimize displacement of surrounding eloquent structures and manipulation of the fornix. An uneventful gross total resection was achieved and confirmed using an angled endoscope to inspect the cavity walls, the "exoscopic to endoscopic or E2E approach" (Video 1). The patient developed transient short-term memory dysfunction in the immediate postoperative period, likely due to retraction of the fornix, which dramatically improved with speech therapy and rehabilitation. The patient provided informed consent for surgery and video recording.
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Affiliation(s)
- Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
| | - Andrew Brunswick
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
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32
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Rothschild BM, Zdilla MJ, Jellema LM, Lambert HW. Cribra orbitalia is a vascular phenomenon unrelated to marrow hyperplasia or anemia: Paradigm shift for cribra orbitalia. Anat Rec (Hoboken) 2020; 304:1709-1716. [PMID: 33135369 DOI: 10.1002/ar.24561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/12/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023]
Abstract
The orbital phenomenon, cribra orbitalia, has long been a source of controversy, especially with regard to its nature, derivation, and relationship to anemia. Therefore, the external surfaces of orbital roofs were systematically examined microscopically in human skulls from historical collections. Superior orbital surfaces of 278 individual crania within the Hamann-Todd collection were assessed at various magnifications using epi-illumination microscopy to identify the presence of cribra orbitalia and characterize its nature. Also, 12 additional individuals with diagnosed anemia in the Hamann-Todd collection were evaluated. Orbital roof alterations, present in one-third of examined crania, had two discrete appearances: Vascular grooves (45%) and application of new bone in a vascular branching pattern on the orbit surface (55%). Porosity of the orbit was not observed. Evaluation of the orbits of 12 individuals with diagnosed anemia revealed one with a single deep defect, suggesting a space-occupying phenomenon, but no evidence of bone accretion, vascular grooves, or porosity. Cribra orbitalia has often been lumped indiscriminately as an indicator of organismal stress, rather than identified as a indicating a specific etiology. Neither that perspective nor porosity are supported by high resolution examination of orbital roof changes. Recognition of the blood vessel imprint pattern falsifies previous speculations and provides a new paradigm. The actual character of cribra orbitalia is documented and new hypotheses generated. While population prevalence of cribra orbitalia seems excessive for explanation on the basis of these hypotheses, the imprints are clearly vascular in origin.
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Affiliation(s)
- Bruce M Rothschild
- Department of Vertebrate Paleontology, Carnegie Museum, Pittsburgh, Pennsylvania, USA
| | - Matthew J Zdilla
- Departments of Biology & Physician Assistant Studies, West Liberty University, West Liberty, West Virginia, USA.,Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University Anatomy Division, Morgantown, West Virginia, USA
| | - Lyman M Jellema
- Department of Physical Anthropology, Cleveland Museum of Natural History, Cleveland, Ohio, USA
| | - H Wayne Lambert
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University Anatomy Division, Morgantown, West Virginia, USA
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33
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Cerebral cavernous malformation: Management and outcome during pregnancy and puerperium. A systematic review of literature. J Gynecol Obstet Hum Reprod 2020; 50:101927. [PMID: 33035718 DOI: 10.1016/j.jogoh.2020.101927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral cavernomas malformations (CCMs) are vascular malformations that occur with an incidence of 0,4-0,8 % in general population. The most feared complication is cerebral hemorrhage. Currently there are no guidelines for pregnant women with CCMs. Some authors claimed that many physiological changes related to pregnancy could be linked to an high risk of rupture and bleeding of the cerebral cavernoma. However, more recent studies highlight that the presence of cerebral cavernomatosis is not a contraindication for pregnancy and that the risk of bleeding is similar in pregnant and in non-pregnant women. AIM OF THE STUDY The purpose of our work is to analyze, through the study of controversial findings in literature, all the information currently available trying to establish a common approach for management of women with cerebral cavernomatosis in pregnancy, during childbirth and in the puerperium. FINDINGS In accordance with existing literature, pregnancy does not appear to be a significant risk factor for the worsening of clinical manifestations associated with the presence of CCMs. Vaginal delivery is not contraindicated in patients with CCMs and there is no indication to perform cesarean section to reduce the incidence of hemorrhage. The only indication for neurosurgery of CCMs in pregnancy is the presence of rapidly progressive symptoms and should be postponed to the puerperium if arises after 30 weeks. The puerperium is a critical time for the woman with cavernomas for the possibility of bleeding and clinical observation must be continued. CONCLUSION The patients with a diagnosis of a CCMs can have a pregnancy without any particular risk to themselves and the fetus but should be addressed to highly specialized obstetrics center to assesses the initial individual risk related to their pathology and to follow the pregnancy.
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34
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Zhang Y, Yang X. The Roles of TGF-β Signaling in Cerebrovascular Diseases. Front Cell Dev Biol 2020; 8:567682. [PMID: 33072751 PMCID: PMC7530326 DOI: 10.3389/fcell.2020.567682] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
Cerebrovascular diseases are one of the leading causes of death worldwide, however, little progress has been made in preventing or treating these diseases to date. The transforming growth factor-β (TGF-β) signaling pathway plays crucial and highly complicated roles in cerebrovascular development and homeostasis, and dysregulated TGF-β signaling contributes to cerebrovascular diseases. In this review, we provide an updated overview of the functional role of TGF-β signaling in the cerebrovascular system under physiological and pathological conditions. We discuss the current understanding of TGF-β signaling in cerebral angiogenesis and the maintenance of brain vessel homeostasis. We also review the mechanisms by which disruption of TGF-β signaling triggers or promotes the progression of cerebrovascular diseases. Finally, we briefly discuss the potential of targeting TGF-β signaling to treat cerebrovascular diseases.
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Affiliation(s)
- Yizhe Zhang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences, Beijing Institute of Lifeomics, Beijing, China
| | - Xiao Yang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences, Beijing Institute of Lifeomics, Beijing, China
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35
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Maor GS, Faden MS, Brown R. Prevalence, risk factors and pregnancy outcomes of women with vascular brain lesions in pregnancy. Arch Gynecol Obstet 2020; 301:665-670. [PMID: 32060681 DOI: 10.1007/s00404-020-05451-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Vascular brain lesions (VBL) occur in up to 4.0% of the general population. With the increasing availability and use of sophisticated imaging techniques, there are more patients being diagnosed with asymptomatic intracranial AVMs and cavernous hemangiomas. OBJECTIVES Here we evaluate the association between VBL in pregnancy and the maternal and fetal outcomes. STUDY DESIGN The study cohort was identified by isolating all pregnancies from the nationwide inpatient sample (NIS), from the healthcare cost and utilization project (HCUP) over a five-year period. Within this cohort, cases with an arteriovenous malformation (AVM) or cerebral vascular malformations (CVM) were identified and their prevalence was calculated. Baseline demographic characteristics were compared and the odds ratios for various complications and outcomes were calculated. RESULTS Amongst 4,012,396 deliveries, VBL were identified in 214 cases: a prevalence of 5.33 cases per 100,000 deliveries. Majority of VBL cases were identified in women between 25 and 35 years of age, but the proportion of women aged 35 and older was greater amongst those patients with VBL. 74% of cases were of Caucasian race and more cases with VBL had a private insurance payer (62.1%). Seizure disorders were present in 63.6% of the cases with VBL. Whilst VBL are not associated with unfavorable obstetrical complications, they are more likely to be delivered by caesarean section (CS) - 79% of VBL cases were delivered by CS compared to 33% of the patients without VBL (OR 7.03 CI 95% 4.98-9.92). Instrumental delivery was performed in 10.3% of the vaginal deliveries for index cases. Index cases were less prone to fetal growth restriction. VBL accounted for 8.4% of 166 cases of intracranial bleeding occurring during the antepartum period within the entire pregnant population. CONCLUSIONS Presence of VBL does not appear to carry additional risk to mother or fetus during pregnancy.
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Affiliation(s)
- Gil Shechter Maor
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada. .,Department of Obstetric and Gynecology, Meir Medical Center, 59 Tcharnichovsky st., Kfar Saba, Israel.
| | - Majed S Faden
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada.,Department of Maternal Fetal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Richard Brown
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
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Bernasconi A, Cendes F, Theodore W, Gill RS, Koepp M, Hogan RE, Jackson G, Federico P, Labate A, Vaudano AE, Blümcke I, Ryvlin P, Bernasconi N. Response to commentary on recommendations for the use of structural
MRI
in the care of patients with epilepsy: A consensus report from the
ILAE
Neuroimaging Task Force. Epilepsia 2019; 60:2143-2144. [DOI: 10.1111/epi.16324] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Fernando Cendes
- Department of Neurology University of Campinas‐UNICAMP Campinas SP Brazil
| | | | - Ravnoor S. Gill
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Matthias Koepp
- Institute for Neurology University College London London UK
| | - Robert Edward Hogan
- Department of Neurology Washington University Scholl of Medicine St. Louis MO USA
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Heidelberg Victoria Australia
| | - Paolo Federico
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Angelo Labate
- Institute of Neurology University of Catanzaro Catanzaro Italy
| | - Anna E. Vaudano
- Neurology Unit OCASE Hospital AOU Modena University of Modena and Reggio‐Emilia Modena Italy
| | - Ingmar Blümcke
- Department of Neuropathology University Hospital Erlangen Erlangen Germany
| | - Philippe Ryvlin
- Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
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37
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Malek I, Sayadi J, Mekni M, Lahmer A, Henchiri M, Douira W, Nacef L. Partial third nerve palsy revealing cerebral cavernomatosis. J Fr Ophtalmol 2019; 42:e415-e417. [PMID: 31230898 DOI: 10.1016/j.jfo.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- I Malek
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie.
| | - J Sayadi
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie
| | - M Mekni
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie
| | - A Lahmer
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie
| | - M Henchiri
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie
| | - W Douira
- Service de Radiologie, Hôpital Bechir Hamza, faculté de médecine de Tunis, université El Manar, Tunis, Tunisie
| | - L Nacef
- Service A d'ophtalmologie, Institut Hedi Rais d'ophtalmologie, Faculté de médecine de Tunis, Université El Manar, Tunis, Tunisie
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Ren J, Hong T, He C, Sun L, Li X, Ma Y, Yu J, Ling F, Zhang H. Coexistence of Intracranial and Spinal Cord Cavernous Malformations Predict Aggressive Clinical Presentation. Front Neurol 2019; 10:618. [PMID: 31249549 PMCID: PMC6584750 DOI: 10.3389/fneur.2019.00618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Patients with spinal cord cavernous malformations (CMs) are at increased risk for multiple neuraxis CMs. Few studies focused on the natural history of patients with coexistence of intracranial and spinal cord CMs. Methods: Forty patients who underwent both intracranial and spinal MR imaging from a single center were reviewed retrospectively. American Spinal Injury Association (ASIA) impairment scale was used to evaluate neurological and disability status. Results: The median age of the 40 patients was 40.6 years old (range 9–69), and the male-to-female ratio was 2.1:1. The mean size of the intramedullary lesions was 10.1 ± 5.8 mm (range, 3.0–34.0 mm). Six patients (15%) harbored at least one intracranial lesion. Five of the 6 patients (83.3%) suffered aggressive clinical presentations with severe neurological and disability status; in patients with sporadic spinal CMs, the proportion was 26.5% (9 of 34). Coexistence of intracranial and spinal cord CMs is more likely to follow an aggressive course (P = 0.031, OR = 19.547, 95% CI = 1.322–289.123). In the postoperative long-term follow up, the unfavorable rate of patients with associated intracranial CMs was significantly higher than that of patients with sporadic spinal cord CMs (P = 0.049). Conclusions: The prevalence of associated intracranial CMs in patients with spinal cord CMs was 15%. Coexistence of intracranial and spinal cord CMs is more likely to follow an aggressive course. This study highlights the necessity of intracranial MR imaging for patients with spinal cord CMs to benefit to the predicting prognosis and selection of treatment strategies.
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Affiliation(s)
- Jian Ren
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuan He
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Sun
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Li
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaxing Yu
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
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39
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Zoia C, Bongetta D, Dorelli G, Luzzi S, Maestro MD, Galzio RJ. Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature. Surg Neurol Int 2019; 10:76. [PMID: 31528414 PMCID: PMC6744740 DOI: 10.25259/sni-132-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Cavernomas arising in the region of the optic apparatus are extremely rare, accounting for <1% of all the central nervous system cavernomas. Most patients are affected by acute visual disturbances related to hemorrhagic events. A prompt resection of the lesion together with a decompression of the optic apparatus may lead to a functional improvement. Almost all patients reported in literature were treated by means of a craniotomy, whereas only few papers described the use of a transnasal approach. Case Description: We report the case of a 53-year-old woman with a hemorrhagic, cavernous malformation of the optic chiasm region and we discuss the technical nuances of the endoscopic transnasal approach we employed. We also review literature for patients with cavernomas treated with a transsphenoidal approach. In our case, the patient underwent the gross-total resection of the lesion through a fully endoscopic transnasal route and the visual disturbances improved immediately after the operation. The ventral access allowed an adequate exposure of the chiasm/anterior circulation complex, thus avoiding an excessive dissection and retraction of neurovascular structures. Moreover, with the aid of angled scopes, we were able to identify the frail vascular supply of the chiasm by employing the suprachiasmatic corridor as well as the infrachiasmatic one. We stress the need for a careful reconstruction of the skull base to avoid a postoperative cerebrospinal fluid leak. Conclusions: With the evolution and spreading of the neuroendoscopic techniques, in selected cases, we advocate the use of the transnasal route for the removal of cavernomas arising in the region of the anterior optic pathways.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Gianluigi Dorelli
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
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