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Galvão GDF, Neumann VB, Verly G, Valença P, Cunha AM, da Silva MR, Domingues FS, de Souza JM. Clinical Features, Hemorrhage Risk and Epilepsy Outcomes of Familial Cerebral Cavernous Malformation: a 20-year Observational Pragmatic Single-Center Study: Clinical Outcomes of Familial CCM: a 20-year Observational Study. J Stroke Cerebrovasc Dis 2024:108041. [PMID: 39332546 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108041] [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: 07/29/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 09/29/2024] Open
Abstract
INTRODUCTION Familial Cerebral Cavernous Malformations (fCCMs) are rare, hereditary conditions characterized by multiple central nervous system lesions. Despite their rarity, CCMs can cause significant clinical challenges when symptomatic, manifesting as seizure and symptomatic hemorrhage (CASH). Guidelines suggest neurosurgical intervention for symptomatic or previously symptomatic lesions, while conservative management is recommended for new-onset epilepsy. However, the natural history and optimal management remain unclear, necessitating further research. OBJECTIVE This study aims to provide a comprehensive analysis of the clinical features, hemorrhage risk, and epilepsy outcomes in fCCM patients over an extended follow-up period, offering a more precise estimate of CASH and epilepsy rates in this population. METHODS This retrospective longitudinal cohort study included fCCM patients enrolled from 2001 to May 2024. Data collected included demographic information, new neurological symptoms, symptomatic hemorrhages, seizures, and modified Rankin Scale (mRS) scores. Incidence rates of first symptomatic events and Kaplan-Meier survival curves were calculated, with logistic and Cox-proportional hazard regression models used to evaluate outcomes. RESULTS A total of 47 patients were included in this study, with a mean age at diagnosis of 37.51 years. At diagnosis, 68% were symptomatic, with 30% having CASH and 36% experiencing seizures without CASH. During a median follow-up of 126.0 months (interquartile range, 110.5 months), 17% had a new CASH event, 20% had seizures without CASH, and 60% remained asymptomatic. The bleeding rate was 1.02% per patient-year, with new focal neurological symptoms at 2.045 per 1000 patient-years and new CASH at 10.225 per 1000 patient-years. Most patients maintained minimal or no disability (mRS 0 or 1). Presenting with epilepsy at baseline significantly increased the odds of future seizures (OR 18.13, p = 0.001). CONCLUSION This study highlights the complex presentation and progression of fCCMs, emphasizing the necessity for long-term monitoring. Baseline epilepsy is a significant predictor of future seizures, underscoring the need for individualized management strategies. Future research with larger cohorts and standardized criteria is essential to refine the understanding and management of fCCMs.
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Affiliation(s)
- Gustavo da Fontoura Galvão
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil; Rio de Janeiro Neurosurgery Center, Rio de Janeiro, RJ, Brazil.
| | - Vinicius Barbosa Neumann
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil.
| | - Gabriel Verly
- Medical School Graduate, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil.
| | - Pablo Valença
- Rio de Janeiro Neurosurgery Center, Rio de Janeiro, RJ, Brazil.
| | - Alexandre Martins Cunha
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil.
| | - Marcello Reis da Silva
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil; Rio de Janeiro Neurosurgery Center, Rio de Janeiro, RJ, Brazil.
| | - Flavio Sampaio Domingues
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil; Rio de Janeiro Neurosurgery Center, Rio de Janeiro, RJ, Brazil.
| | - Jorge Marcondes de Souza
- Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Division of Neurosurgery, Rio de Janeiro, RJ, Brazil; Rio de Janeiro Neurosurgery Center, Rio de Janeiro, RJ, Brazil.
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Kim S, Moon J, Jung KH, Anh SJ, Lee HS, Jang Y, Park KI, Lee SK, Chu K. Clinicoradiologic data of familial cerebral cavernous malformation with age-related disease burden. Ann Clin Transl Neurol 2023; 10:373-383. [PMID: 36629374 PMCID: PMC10014009 DOI: 10.1002/acn3.51728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Familial cerebral cavernous malformation (FCCM) is an autosomal dominant disease induced by loss-of-function mutations in three CCM genes, KRIT1, CCM2, and PDCD10. However, previous studies paid little attention to analyzing the radiologic features and age-related disease burden according to the genes. Therefore, we retrospectively reviewed the genetic tests of our center's clinical FCCM patients. METHOD This study investigated clinical FCCM patients with multiple lesions or a family history of CCMs who underwent the FCCM gene (KRTI1, CCM2, and PDCD10) panel test. The clinical, genetic, and radiologic features were analyzed. RESULT Among the patients (n = 34) undergoing the FCCM gene test, twenty-seven patients had CCM confirmed by brain MRI, and twenty-one patients were considered to have FCCM (cohort 1). In cohort 1, thirteen patients had mutations in the FCCM gene, but eight did not. Cohort 2 comprised cohort 1 and four family members with the same mutation as the probands. Six novel variants in CCM genes were detected (KRIT1 c.22_26del, c.815dup, c.1094_1098del, c.1147-2A>G, c.2124dup, and PDCD10 c.150 + 1dup). Cohort 1 demonstrated that brainstem lesions were mostly associated with the mutation detection in CCM genes (brainstem, lateral temporal, and parietal lesions vs. lateral temporal and parietal lesions, AUC 0.928 vs. 0.779, P = 0.0389). The radiologic severity worsened according to age in the KRIT1 group compared with the Mutation not detected group (correlation coefficient 0.75 (P < 0.001) versus 0.53 (P = 0.004)). CONCLUSION The brainstem lesion could be the radiologic marker for FCCM with the mutation detected. The age-related disease burden regarding FCCM according to genetic information was demonstrated.
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Affiliation(s)
- Seondeuk Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Seon-Jae Anh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea
| | - Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 152, Teheran-ro, Gangnam-gu, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Natural history of familial cerebral cavernous malformation syndrome in children: a multicenter cohort study. Neuroradiology 2023; 65:401-414. [PMID: 36198887 PMCID: PMC9859903 DOI: 10.1007/s00234-022-03056-y] [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: 07/26/2022] [Accepted: 09/17/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE There is limited data concerning neuroimaging findings and longitudinal evaluation of familial cerebral cavernous malformations (FCCM) in children. Our aim was to study the natural history of pediatric FCCM, with an emphasis on symptomatic hemorrhagic events and associated clinical and imaging risk factors. METHODS We retrospectively reviewed all children diagnosed with FCCM in four tertiary pediatric hospitals between January 2010 and March 2022. Subjects with first available brain MRI and [Formula: see text] 3 months of clinical follow-up were included. Neuroimaging studies were reviewed, and clinical data collected. Annual symptomatic hemorrhage risk rates and cumulative risks were calculated using survival analysis and predictors of symptomatic hemorrhagic identified using regression analysis. RESULTS Forty-one children (53.7% males) were included, of whom 15 (36.3%) presenting with symptomatic hemorrhage. Seven symptomatic hemorrhages occurred during 140.5 person-years of follow-up, yielding a 5-year annual hemorrhage rate of 5.0% per person-year. The 1-, 2-, and 5-year cumulative risks of symptomatic hemorrhage were 7.3%, 14.6%, and 17.1%, respectively. The latter was higher in children with prior symptomatic hemorrhage (33.3%), CCM2 genotype (33.3%), and positive family history (20.7%). Number of brainstem (adjusted hazard ratio [HR] = 1.37, P = 0.005) and posterior fossa (adjusted HR = 1.64, P = 0.004) CCM at first brain MRI were significant independent predictors of prospective symptomatic hemorrhage. CONCLUSION The 5-year annual and cumulative symptomatic hemorrhagic risk in our pediatric FCCM cohort equals the overall risk described in children and adults with all types of CCM. Imaging features at first brain MRI may help to predict potential symptomatic hemorrhage at 5-year follow-up.
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Bubenikova A, Skalicky P, Benes V, Benes V, Bradac O. Overview of cerebral cavernous malformations: comparison of treatment approaches. J Neurol Neurosurg Psychiatry 2022; 93:475-480. [PMID: 35273070 DOI: 10.1136/jnnp-2021-328658] [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: 12/15/2021] [Accepted: 01/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The comparison of treatment efficacy for cerebral cavernous malformations (CCMs) has not yet been well researched. DESIGN PubMed, Cochrane Library, Science Direct, ISI Web of Science, Embase and additional sources were searched to identify cohort studies about the treatment of CCMs published between 1990 and 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; the Newcastle-Ottawa Scale was used to assess the risk of bias and to evaluate limitations based on selection/outcome biases. The cumulative incidences with 95% CIs were calculated using the random effects model. The models of Poisson distribution were applied to evaluate risk factors of poorer treatment outcome by calculating rate ratios within 100 person-years with 95% CIs. RESULTS A total of 100 cohorts yielding 8994 patients treated for CCMs within 41 098 person-years of follow-up were analysed. The efficacy of ensuring the prevention of haemorrhage was 97% in surgical, 86% in radiosurgical and 77% in the conservative treatment. The lowest mortality (1%) was after radiosurgery, and the highest persistent morbidity (22%) was in natural history series. Deep-seated and brainstem CCMs were associated with higher bleeding rates. Lobar localisation was a protective factor in all analyses. Patients with history of previous haemorrhage were exposed to higher risk of rebleeding. Male gender was a protective factor associated with lower risk of post-treatment haemorrhage. CONCLUSIONS Surgical resection of CCM is effective in ensuring the prevention of haemorrhage with acceptable morbidity and mortality, but conservative and radiosurgical management is a justified treatment alternative. Brainstem and deep-seated CCMs are predominantly associated with higher haemorrhage rates.
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Affiliation(s)
- Adela Bubenikova
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Skalicky
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Bradac
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic .,Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Santos AN, Rauschenbach L, Saban D, Chen B, Darkwah Oppong M, Herten A, Hadice Gull H, Rieß C, Deuschl C, Schmidt B, Jabbarli R, Wrede KH, Zhu Y, Frank B, Sure U, Dammann P. Multiple Cerebral Cavernous Malformations – Clinical Course of Confirmed, Assumed and Non‐Familial Disease. Eur J Neurol 2022; 29:1427-1434. [DOI: 10.1111/ene.15253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandro N. Santos
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Dino Saban
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Bixia Chen
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Annika Herten
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Hanah Hadice Gull
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Christoph Rieß
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology University Hospital of Essen Essen Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Yuan Zhu
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Benedikt Frank
- Department of Neurology University Hospital Essen Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery University Hospital Essen Essen Germany
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Fox CK, Nelson J, McCulloch CE, Weinsheimer S, Pawlikowska L, Hart B, Mabray MC, Zafar A, Morrison L, Zabramski JM, Akers A, Kim H. Seizure Incidence Rates in Children and Adults With Familial Cerebral Cavernous Malformations. Neurology 2021; 97:e1210-e1216. [PMID: 34389651 PMCID: PMC8480481 DOI: 10.1212/wnl.0000000000012569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/07/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Seizure incidence rates related to familial cerebral cavernous malformation (FCCM) are not well described, especially for children. To measure the seizure incidence rate, examine seizure predictors, and characterize epilepsy severity, we studied a cohort of children and adults with FCCM enrolled in the Brain Vascular Malformation Consortium (BVMC). METHODS Seizure data were collected from participants with FCCM in the BVMC at enrollment and during follow-up. We estimated seizure probability by age and tested whether cerebral cavernous malformation (CCM) counts or genotype were associated with earlier seizure onset. RESULTS The study cohort included 479 FCCM cases. Median age at enrollment was 42.5 years (interquartile range 22.5-55.0) and 19% were children (<18 years old). Median large CCM count was 3 (interquartile range 1-5). Among 393 with genotyping, mutations were as follows: CCM1 (Common Hispanic Mutation) (88%), another CCM1 mutation (5%), CCM2 mutations (5%), and CCM3 mutations (2%). Prior to or during the study, 202 (42%) had a seizure. The cumulative incidence of a childhood seizure was 20.3% (95% confidence interval [CI] 17.0-23.4) and by age 80 years was 60.4% (95% CI 54.2-65.7). More total CCMs (hazard ratio [HR] 1.24 per SD unit increase, 95% CI 1.1-1.4) or more large CCMs (HR 1.5 per SD unit increase, 95% CI 1.2-1.9) than expected for age and sex increased seizure risk. A CCM3 mutation also increased risk compared to other mutations (HR 3.11, 95% CI 1.15-8.45). Individuals with a seizure prior to enrollment had increased hospitalization rates during follow-up (incidence rate ratio 10.9, 95% CI 2.41-49.32) compared to patients without a seizure history. DISCUSSION Individuals with FCCM have a high seizure incidence and those with more CCMs or CCM3 genotype are at greater risk. Seizures increase health care utilization in FCCM.
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Affiliation(s)
- Christine K Fox
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC.
| | - Jeffrey Nelson
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Charles E McCulloch
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Shantel Weinsheimer
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Ludmila Pawlikowska
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Blaine Hart
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Marc C Mabray
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Atif Zafar
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Leslie Morrison
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Joseph M Zabramski
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Amy Akers
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
| | - Helen Kim
- From the Departments of Neurology and Pediatrics (C.K.F.), Center for Cerebrovascular Research (C.K.F., J.N., C.E.M., S.W., L.P., H.K.), Department of Epidemiology and Biostatistics (C.E.M., H.K.), and Institute for Human Genetics (S.W., L.P.), University of California San Francisco; Departments of Radiology (B.H., M.C.M.) and Neurology (L.M.), University of New Mexico, Albuquerque; Department of Medicine (A.Z.), Division of Neurology, University of Toronto, Canada; Department of Neurosurgery (J.M.Z.), Barrow Neurological Institute, Phoenix, AZ; and Angioma Alliance (A.A., H.K.), Durham, NC
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Nisson PL, Wicks RT, Zhao X, James WS, Xu D, Nakaji P. Insular cavernous malformation resection through a minipterional, transsylvian approach. NEUROSURGICAL FOCUS: VIDEO 2019; 1:V26. [PMID: 36285066 PMCID: PMC9541656 DOI: 10.3171/2019.7.focusvid.19148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
Cavernous malformations of the brain are low-flow vascular lesions that have a propensity to hemorrhage. Extensive surgical approaches are often required for operative cure of deep-seated lesions. A 23-year-old female presented with a cavernous malformation of the left posterior insula with surrounding hematoma measuring up to 3 cm. A minimally invasive (mini-)pterional craniotomy with a transsylvian approach was selected. Endoscopic assistance was utilized to confirm complete resection of the lesion. The minipterional craniotomy is a minimally invasive approach that provides optimal exposure for sylvian fissure dissection and resection of many temporal and insular lesions. The video can be found here: https://youtu.be/9z6_EhU6lxs.
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Affiliation(s)
| | - Robert T. Wicks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | | | - David Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
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