Histoire naturelle des cavernomes du système nerveux central

Brain vascular lesions: a clinicopathologic, immunohistochemistry, and ultrastructural approach

Brain vascular malformations are relatively common lesions that cause serious neurologic disability or death in a significant proportion of individuals bearing them. The purpose of this study was to analyze the clinicopathologic and immunohistochemistry these lesions, looking for common antibodies expressed such as CD31, CD34, CD15, factor VIII, nestin, vimentin, vascular endothelial grow factor (VEGF), vascular endothelial grow factor receptor-2 (VEGF-R2), glial fibrillar acidic protien (GFAP), and fibroblastic grow factor β (β-FGF) and ultrastructure in endothelial cells as well as in vessel walls. Fifty cases of vascular lesions were included in this study: 29 (58%) of them were arteriovenous malformations and 21 (52%) were brain cavernomas. Twenty-six (52%) patients were women and 24 (48%) men. The age range was from 13 to 68 years (mean age, 35.86 ± 15.19 years). The size of the lesions ranged between 1 and 8 cm (3 ± 1.65 cm), and parieto-occipital lesions had a bigger size. Evolution time varied from 1 month to 1 year (mean, 7.5 months). There was a significant statistical correlation between age and sex (P = -035), rupture of lesion (P = .015), brain hemorrhage (P = .033), necrosis (P = .011), hemosiderin deposit (P = .042), VEGF (P = .015), and VEGFR (P = .037), as well as localization of rupture (P = .017), loss of consciousness (P = .000), visual deficit (P = .026), hyaline vessels (P = .000), and CD31 (.009). Interactions between endothelial cells and mural cells (pericytes and vascular smooth muscle cells) in blood vessel walls have recently come into focus as central processes in the regulation of vascular formation, stabilization, remodeling, and function in brain vascular lesions. However, the molecular mechanisms that underlie the formation and growth of brain arteriovenous malformations are still poorly understood.

Factors associated with epileptic seizure of cavernous malformations in the central nervous system in West China

OBJECTIVE

To explore the factors associated with preoperative and postoperative epileptic seizure in patients with cavernous malformations (CMs).

METHODS

A total of 52 consecutive patients from January 2009 to June 2011 who underwent surgical treatment in West China Hospital of Sichuan University due to CMs and confirmed by histopathology were retrospectively reviewed.Patients were divided into two groups (epilepsy-group and non-epilepsy group) according to clinical presentation. Other clinical data, treatment procedure, and follow-up information were collected. Engel classification was used to evaluate seizure outcome.

RESULTS

Low birth weight, temporal lobe involvement and cortical lesion showed significant difference between two groups (p=0.017, 0.003 and 0.025 respectively). Cortical lesion highly increased risk for preoperative epileptic seizure (OR=10.48; 95% CI 1.61-68.23). After a mean follow-up of 2.1 years, 77.8% of epileptic patients achieved Engel class I. Temporal lobe involvement, lesion size < 2.5cm and surgery within one year of symptom onset were found associated with better seizure outcome (p=0.016, 0.012 and 0.050). Temporal lobe involvement significantly decreased the risk for postoperative epileptic seizure (OR=0.038; 95% CI 0.002-0.833). Application of ECoG made no significant difference to seizure outcome (p=0.430). Most patients need continuing medication therapy after surgery.

CONCLUSION

Surgical treatment of patient with CMs is satisfactory in most cases and temporal lobe involvement usually predict favourable postoperative seizure outcome whether under the monitoring of ECoG or not. Thus, epileptic patients with CMs should be considered for surgical treatment especially when cortical brain layer or temporal lobe was involved.

Natural history of cerebral dot-like cavernomas

AIM

To elucidate the natural history of dot-like or "black spot" cavernomas.

MATERIALS AND METHODS

Data of 18 children with black spot cavernomas were analysed retrospectively.

RESULTS

Eleven boys and seven girls presented 187 black spot cavernomas during a mean observation period of 5.5 years. Mean and median age at diagnosis of the 187 cavernomas was 9.6 years. There were 70 de novo black spot cavernomas. Boys presented significantly more cavernomas than girls. There were three KRIT1 mutation carriers and four PDCD 10 mutation carriers. Children with a PDCD 10 mutation presented significantly more lesions than those children with a KRIT1 mutation (mean number of lesions per patient: 23.3 versus 3.3, respectively). There were 10 radiological haemorrhagic events caused by 10 black spot lesions. Two of these events were symptomatic. The haemorrhage rate of black spot cavernomas was 0.7% per lesion-year.

CONCLUSIONS

A mean bleeding rate of 0.7% per lesion-year is lower than the overall haemorrhage rates provided in the literature. Nonetheless, black spot cavernomas are not purely benign lesions. Furthermore, genetic mutations may play a role in the natural history of black spot cavernomas.

Cavernous hemangioma of the optic chiasm: a surgical review

OBJECTIVES

To report a new case of cavernous hemangioma of the optic chiasm and to review all previously published cases with regard to presentation, surgical treatment, and outcomes.

DESIGN

Case report and literature review.

MAIN OUTCOME MEASURES

Cases identified though PubMed and published literature. Presentation states of patients in terms of visual loss and pituitary function. Surgical approaches, operations performed, and outcomes of the surgery.

RESULTS

thirty-nine previously reported cases were studied with the present case. All 40 patients presented with visual failure. Where documented, there was an 20% pituitary dysfunction rate. A total of 32 craniotomies were reported. Seventy-eight percent of patients underwent decompression including hematoma evacuation and partial or complete removal of the cavernoma, with improvement in visual function in 87% of these patients. The patients undergoing only biopsy showed stable visual function in 50% with further deterioration in 50%.

CONCLUSIONS

We conclude that this rare condition can be managed with good outcomes in terms of visual improvement, provided a high index of suspicion is maintained and the goals of surgery for emergency patients are maintained to include chiasmal decompression. Although complete resection of the lesion is frequently possible, it should not be the primary aim of surgery.

Differential diagnosis of nontraumatic intracerebral hemorrhage

A wide variety of nontraumatic pathologies can result in intracerebral hemorrhage (ICH). Primary causes such as arterial hypertension or cerebral amyloid angiopathy can be differentiated from secondary pathologies, such as neoplasms, arterio-venous malformations, coagulopathies, hemorrhagic ischemic strokes, and cerebral venous and sinus thrombosis.Here, the authors first provide some general information on epidemiology, clinical presentation, and imaging appearance of ICHs followed by a detailed discussion of the different underlying pathologic entities and their imaging presentation.

[Radiation-induced cavernoma of the central nervous system]

Central nervous system radiation-induced cavernoma (RIC) is a rare entity. We report one case with a review of the literature. This case illustrates the following features: mean age of 11.7 years at time of radiation and mean latency period of nine years for these RIC, which are often numerous (38%), and located in the field of the craniospinal radiation therapy. This nosological entity belongs to the spectrum of radiation-induced lesions, and requires a long-term MRI follow up in patients who underwent cranial radiation therapy.