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Li Z, Chen L, Wang J, Dong G, Jia G, Jia W, Li D. Cavernous Malformation From Cranial Nerves: A Systematic Review With a Novel Classification and Patient-Level Analysis. Neurosurgery 2024:00006123-990000000-01194. [PMID: 38842326 DOI: 10.1227/neu.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cavernous malformations (CMs) occurring in the cranial nerve (CN) are extremely rare, and there is currently no comprehensive review on CN CMs, leading to a lack of sufficient understanding of CN CMs. We aimed to systematically review all published CN CM cases; summarize the epidemiology, clinical manifestations, treatment, and prognosis of CN CMs; and identify factors influencing the prognosis of CN CMs. METHODS This systematic review identified all cases potentially diagnosed with CN CM through a systematic search of PubMed, SCOPUS, Web of Science, and Cochrane databases. This represents the most comprehensive systematic review to date. We classified CN CMs based on their anatomic origins. Patient characteristics, disease manifestations, treatment approaches, and prognosis were summarized descriptively. Further analysis was conducted to identify factors influencing the prognosis of CN CMs. RESULTS The final analysis included 108 articles (127 individual patient cases). The optic nerve (49/128, 38.3%) is the most commonly affected nerve. Notably, CN CMs can be categorized into 3 types: Intraneural, Perineural, and Extraneural. Preoperative nerve function status and novel classification were associated with the prognosis of CN CMs (P = .001; P < .001). The postoperative neurological deterioration rate for the Intraneural type was 19/37 (51.4%); for the Extraneural type, it was 13/69 (18.8%); and for the Perineural type, it was 1/22 (4.5%) (P < .001). CONCLUSION We reviewed all the published CN CMs to date, offering a comprehensive description of CN CMs for the first time and identifying prognostic factors. The classification of CN CMs proposed in this study could serve as guidance for the selection of intraoperative treatment regimens. The findings of this systematic review are expected to provide a foundation for clinical decision-making in this crucial rare disease and lay the groundwork for developing relevant clinical guidelines.
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Affiliation(s)
- Ziyang Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liangpeng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junmei Wang
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gehong Dong
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guijun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Beijing Neurosurgical Institute, Beijing, China
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Beijing Neurosurgical Institute, Beijing, China
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Akgun B, Aytekın A, Balta H, Yıldırım G. A Large Intracranial Cystic Cavernous Angioma. Neurol India 2024; 72:429-430. [PMID: 38691494 DOI: 10.4103/ni.neurol-india-d-23-00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 05/03/2024]
Affiliation(s)
- Bekir Akgun
- Department of Neurosurgery, Firat University Hospital, Elazig, Turkıye
| | - Akin Aytekın
- Department of Neurosurgery, Firat University Hospital, Elazig, Turkıye
| | - Hilal Balta
- Department of Clinical Pathology, Firat University Hospital, Elazig, Turkıye
| | - Gokhan Yıldırım
- Department of Neurosurgery, Firat University Hospital, Elazig, Turkıye
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Hassanzadeh S, Gao L, Alvarado AM, Camarata PJ, Lakis NS, Haeri M. Extra-Axial Cavernous Angioma: A Case Report and Review of the Literature. Neurol Int 2024; 16:162-185. [PMID: 38251058 PMCID: PMC10801606 DOI: 10.3390/neurolint16010010] [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: 11/15/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Cavernous angiomas (CAs) are benign vascular malformations predominantly seen in the brain parenchyma and therefore referred to as intra-axial. Extra-axial dural-based cavernous angiomas, on the other hand, are rare vascular lesions found outside of the brain parenchyma. They occur in the middle fossa and may be easily misdiagnosed as meningiomas due to their extra-axial location. In addition, CAs that are located outside the middle fossa, such as in the convexity, have a better prognosis since they are more surgically accessible. Surgical resection is the main treatment of choice in CAs. However, other options, such as embolization and radiotherapy, may also be considered therapeutic choices or additive treatment options. The pathogenesis of CA and the involvement of other factors (genetics or environmental factors) are still unknown and require further investigation. We are presenting a young man who presented for evaluation of seizure-like events without any family history of neurologic conditions. The physical examination was unremarkable except for a slightly antalgic gait. Imaging studies showed an extra-axial left tentorial mass suggestive of a meningioma, hemangiopericytoma, or other extra-axial lesions. The lesion was resected where its vascular nature was mentioned initially, and the histology proved the diagnosis of cavernous angioma. Here we give an overview of the known pathogenesis, causes, clinical features, and diagnostic and therapeutic options in CA. Better knowledge about CA, its causes, clinical features, and treatment options would help clinicians in early diagnosis and patient management.
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Affiliation(s)
- Shakiba Hassanzadeh
- Department of Pathology and Laboratory Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Linlin Gao
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Anthony M. Alvarado
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Paul J. Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Nelli S. Lakis
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Mohammad Haeri
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Shroff K, Deopujari C, Karmarkar V, Mohanty C. Cystic Cerebral Cavernous Malformations: Report of Five Cases and a Review of Literature. Asian J Neurosurg 2023; 18:272-292. [PMID: 37397055 PMCID: PMC10310445 DOI: 10.1055/s-0043-1768577] [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] [Indexed: 07/04/2023] Open
Abstract
Introduction Cerebral cavernous malformations (CCMs) account for about 5 to 13% of intracranial vascular malformations. Cystic cerebral cavernous malformations (cCCMs) are a rare morphological variant and can cause diagnostic and therapeutic dilemmas. We describe our five such cases and review the existing literature on this entity. Methods A search of the PubMed database for cCCMs was done, and all articles in English emphasizing the reporting of cCCMs were selected. A total of 42 publications describing 52 cases of cCCMs were selected for analysis. Epidemiological data, clinical presentation, imaging features, the extent of resection, and outcome were analyzed. Radiation-induced cCCMs were excluded. We have also described five of our cases of cCCMs and reported our experience. Results The median age at presentation was 29.5 years. Twenty-nine patients had supratentorial lesions, 21 had infratentorial lesions, and 2 had lesions in both compartments. Among our four patients, three had infratentorial lesions, whereas one had a supratentorial lesion. Multiple lesions were seen in four patients. A majority (39) had symptoms of mass effect (75%), and 34 (65.38%) had raised intracranial pressure (ICP), whereas only 11 (21.15%) had seizures. Among our four operated patients, all of them had symptoms of mass effect, and two of them also had features of raised ICP. The extent of resection was gross total in 36 (69.23%), subtotal in 2 (3.85%), and not reported in 14 (26.93%). All four of our operated patients underwent gross total resection, but two of them underwent a second surgery. Of the 48 patients in whom the surgical outcome was reported, 38 improved (73.08%). One showed a transient worsening followed by improvement, one developed a worsening of the pre-existing focal neurological deficit (FND), two developed a new FND, and 5 had no improvement in their FNDs. Death occurred in one patient. All four of our operated patients improved after surgery, although three of them showed a transient worsening of FNDs. One patient is under observation. Conclusion cCCMs are rare morphological variants and can cause considerable diagnostic and therapeutic dilemmas. They should be considered in the differential diagnosis of any atypical cystic intracranial mass lesion. Complete excision is curative, and the outcome is generally favorable; although transient deficits may be seen.
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Affiliation(s)
- Krishna Shroff
- Department of Neurosurgical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Ozaki K, Higuchi Y, Nakano S, Horiguchi K, Yamakami I, Iwadate Y. Arachnoid cyst alone causes hemifacial spasm: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2275. [PMID: 36303502 PMCID: PMC9379708 DOI: 10.3171/case2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) due to an arachnoid cyst at the cerebellopontine angle is rare. Here, the authors reported such a case and analyzed the mechanism of facial nerve hyperactivity by reviewing the literature. OBSERVATIONS A 40-year-old man presented with right HFS for the past 3 years. Preoperative magnetic resonance imaging revealed a right cerebellopontine angle cystic mass with high intensity on T2-weighted images, low intensity on T1-weighted and diffusion-weighted images, and no contrast effects. Cyst excision and decompression of the facial nerve using a lateral suboccipital approach to monitor abnormal muscle response (AMR) resulted in permanent relief. The cyst was histologically compatible with an arachnoid cyst. LESSONS In the present case, when the cyst was dissected, the AMR disappeared and no offending arteries were detected around the root exit zone. Therefore, the cyst itself was responsible for HFS, for which AMR was useful. Limited cases of HFS due to arachnoid cysts without neurovascular compression have been previously reported. The authors suggested that pulsatile compression by the cyst results in facial nerve hyperactivity and secondary HFS.
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Affiliation(s)
- Ko Ozaki
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and
| | - Shigeki Nakano
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and
| | - Kentaro Horiguchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and
| | - Iwao Yamakami
- Department of Neurosurgery, Seikeikai Chiba Medical Center, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and
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Abujarir RH, Ayyad A, Sotouhy A, Bozom E, Shaaban A, Kubaissi AA. Convexity Dura-Based Cerebral Cavernous Malformation Mimicking Meningioma: A Case Report and Literature Review. Asian J Neurosurg 2022; 17:120-126. [PMID: 35873845 PMCID: PMC9298532 DOI: 10.1055/s-0042-1749109] [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] [Indexed: 11/15/2022] Open
Abstract
Cavernous angioma, cavernoma, cavernous hemangioma, also called cerebral cavernous malformation (when present in the brain), are benign vascular malformations, usually intraparenchymal; however, a few reported cases are in the extra-axial location—as middle cranial fossa, near the cavernous sinuses, and in the cerebellopontine angle—and are rarely reported as dura-based convexity lesion resembling meningioma. We report a giant dura-based, convexity, a cerebral cavernous malformation. We wish to notify the case as occurring at a rare location and a large-sized cerebral cavernous malformation. A case of young female presented with a long-standing history of headache. Computed tomography scan and magnetic resonance imagings (MRIs) suggested right occipital dura-based large mass lesion of approximately 5 cm in diameter. The lesion was excised and pathology studies confirmed the diagnosis of a cerebral cavernous malformation. A follow-up MRI confirmed total resection of the lesion and the patient had a smooth postoperative recovery.
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Affiliation(s)
| | - Ali Ayyad
- Neurosurgery Unit, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Sotouhy
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Essam Bozom
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Shaaban
- Neurosurgery Unit, Hamad Medical Corporation, Doha, Qatar
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Ke D, Deng X, Li X, Li J, Hui X. Calcified extra-axial cavernous malformation arising from lower cranial nerves: A case report and literature review. Medicine (Baltimore) 2021; 100:e24566. [PMID: 33592913 PMCID: PMC7870219 DOI: 10.1097/md.0000000000024566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Extra-axial cavernous malformations (ECMs) arising from cranial nerves (CNs) are rare. Complete "en bloc" lesion resection and hemosiderin-stained tissue preservation remain the standard treatment, while a different strategy may be needed when the lesion is highly calcified . We report the 3rd calcified ECM-CN and review the clinical features and surgical strategy for this rare condition considering previous literature. PATIENT CONCERNS We present a 52-year-old woman with a calcified lesion located in the right lower 1/3 of the cerebellopontine angle. DIAGNOSIS The diagnosis was calcified ECM-CNs according to the pathological and radiological features. INTERVENTIONS A posterior midline craniotomy was performed, and piecemeal resection of the lesion was carried out. Subtotal resection of the lesion was achieved with a small piece left in situ. OUTCOMES No symptom or lesion-related recurrence was found during 28 months of follow-up. LESSONS Calcified ECM-CNs are unique cavernous malformations arising from CNs. Piecemeal resection and subtotal or near-total excision are 2 major aspects that differ from the surgical strategy for general ECM-CNs.
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Affiliation(s)
- Daibo Ke
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Xueyun Deng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Xiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
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Abuzayed B, Said A, Jamous O, Al-Ashqar O, Al-Abadi H, Alawneh K. Extra-axial cerebellopontine angle cavernoma: A case report and review of literature. Surg Neurol Int 2020; 11:386. [PMID: 33408920 PMCID: PMC7771499 DOI: 10.25259/sni_664_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location. Case Description: A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma. Conclusion: Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.
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Affiliation(s)
- Bashar Abuzayed
- Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan
| | - Anas Said
- Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan
| | - Osama Jamous
- Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan
| | - Omar Al-Ashqar
- Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan
| | - Hussein Al-Abadi
- Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan
| | - Khalid Alawneh
- Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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