Telangiectases and cavernous angiomas of the brainstem: ?cryptic? vascular malformations

G. H. Roberson; C. S. Kase; E. R. Wolpow

doi:10.1007/bf00345039

An analysis of the natural history of cavernous angiomas

Journal of Neurosurgery ◽

10.3171/jns.1991.75.5.0702 ◽

1991 ◽

Vol 75 (5) ◽

pp. 702-708 ◽

Cited By ~ 547

Author(s):

O. Del Curling ◽

David L. Kelly ◽

Allen D. Elster ◽

Timothy E. Craven

Keyword(s):

Natural History ◽

Mr Imaging ◽

Vascular Malformations ◽

Medical Center ◽

Cavernous Angioma ◽

Neurological Deficits ◽

Surgical Removal ◽

Cavernous Angiomas ◽

History Of ◽

Estimated Risk

✓ The advent of magnetic resonance (MR) imaging has permitted the recognition of many angiographically occult vascular malformations before the development of complications and subsequent surgical removal. This study reviews all patients at one institution who had radiographically identifiable vascular malformations believed to represent cavernous angiomas in order to obtain information on the natural history of this particular lesion. All 8131 craniospinal MR images performed at our medical center from January 1, 1986, to November 30, 1989, were reviewed, and 32 patients were identified with 76 lesions meeting the MR imaging criteria for cavernous angioma. Medical histories, physical examination records, and other data from these patients were then reviewed to determine the frequency of complications. Their mean age at latest follow-up examination (or at surgical removal of the lesion) was 37.6 years (range 16 to 72 years). Sixteen patients (50%) had a history of seizures, seven (22%) had focal neurological deficits, and three (9%) had clinically significant hemorrhage attributable to the cavernous angioma; six patients (19%) were asymptomatic. The estimated risk of hemorrhage for this population is 0.25%/person-year of exposure; the estimated risk of seizure development is 1.51%/person-year. Eight patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit. Although these lesions are often excised with relative ease and minimal morbidity, the potential risks and benefits of surgery must be weighed carefully before removal of these relatively benign malformations.

Download Full-text

Utility of preoperative functional magnetic resonance imaging for identifying language cortices in patients with vascular malformations

Neurosurgical FOCUS ◽

10.3171/foc.2002.13.4.5 ◽

2002 ◽

Vol 13 (4) ◽

pp. 21-32 ◽

Cited By ~ 11

Author(s):

Nader Pouratian ◽

Susan Y. Bookheimer ◽

David E. Rex ◽

Neil A. Martin ◽

Arthur W. Toga

Keyword(s):

Magnetic Resonance ◽

Sensitivity And Specificity ◽

Language Processing ◽

Sentence Comprehension ◽

Vascular Malformations ◽

Imaging Modality ◽

Visual Object ◽

Functional Magnetic Resonance ◽

Cavernous Angiomas ◽

Matching Criteria

Object The goal of this study was to evaluate the utility of preoperative functional magnetic resonance (fMR) imaging in the prediction of whether a given cortical area would be deemed essential for language processing by electro-cortical stimulation mapping (ESM). Methods The authors studied patients with vascular malformations, specifically arteriovenous malformations (AVMs) and cavernous angiomas, in whom blood-flow patterns are not normal and in whom a perfusion-dependent mapping signal may be questionable. Ten patients were studied (seven harboring AVMs and three with cavernous angiomas). The authors used a battery of linguistic tasks, including visual object naming, word generation, auditory responsive naming, visual responsive naming, and sentence comprehension, to identify brain regions that were consistently activated across expression and comprehension linguistic tasks. In a comparison of ESM and fMR imaging activations, the authors varied the matching criteria (overlapping activations, adjacent activations, and deep activations) and the radii of influence of ESM (2.5, 5, and 10 mm) to determine the effects of these factors on the sensitivity and specificity of fMR imaging. The sensitivity and specificity of fMR imaging were dependent on the task, lobe, and matching criterion. For the population studied, the sensitivity and specificity of fMR imaging activations during expressive linguistic tasks were found to be up to 100 and 66.7%, respectively, in the frontal lobe, and during comprehension linguistic tasks up to 96.2 and 69.8%, respectively, in the temporal and parietal lobes. The sensitivity and specificity of each disease population (patients with AVMs and those with cavernous angiomas) and of individuals were consistent with those values reported for the entire population studied. Conclusions The authors conclude that preoperative fMR imaging is a highly sensitive preoperative planning tool for the identification of which cortical areas are essential for language and that this imaging modality may play a future role in presurgical planning for patients with vascular malformations.

Download Full-text

Simultanea presenza di teleangiectasie capillari, anomalie di sviluppo venoso e angiomi cavernosi

Rivista di Neuroradiologia ◽

10.1177/19714009970100s2116 ◽

1997 ◽

Vol 10 (2_suppl) ◽

pp. 253-255

Author(s):

S. Schiavoni ◽

S. Ballerini ◽

D. Capello ◽

N. Mavilio ◽

T. Arcuri ◽

...

Keyword(s):

Cerebral Hemisphere ◽

Vascular Malformations ◽

Simultaneous Presence ◽

Cavernous Angiomas

This is the case of a 22 year old woman who was studied by us for headache. The neuroradiologic study demonstrated the presence of capillary telangiectases, DVA and cavernous angiomas in the same cerebral hemisphere. The simultaneous presence of these three kinds of vascular malformations could be due to a single pathological entity with different manifestations.

Download Full-text

Intradural Extramedullary Cavernous Angioma: Case Report

Neurosurgery ◽

10.1227/00006123-199112000-00023 ◽

1991 ◽

Vol 29 (6) ◽

pp. 924-926 ◽

Cited By ~ 22

Author(s):

Luciano Mastronardi ◽

Luigi Ferrante ◽

Marco Scarpinati ◽

Franco Maria Gagliardi ◽

Paolo Celli ◽

...

Keyword(s):

Case Report ◽

Vertebral Body ◽

Vascular Malformations ◽

Cavernous Angioma ◽

Cavernous Angiomas ◽

Spinal Vascular Malformations ◽

Rare Malformation ◽

Body Level ◽

Intradural Extramedullary ◽

Extradural Space

Abstract Cavernous angiomas represent 5 to 12% of spinal vascular malformations and usually are located at the vertebral body level with possible extension into the extradural space. The intradural intramedullary cavernoma occurs in about 3% of cases, whereas extramedullary localization is extremely rare. A new case of an intradural extramedullary cavernous angioma is reported, and the clinical, diagnostic, and therapeutic aspects of this rare malformation are analyzed.

Download Full-text

Cavernous angiomas of the central nervous system in children

Journal of Neurosurgery ◽

10.3171/jns.1992.76.1.0038 ◽

1992 ◽

Vol 76 (1) ◽

pp. 38-46 ◽

Cited By ~ 151

Author(s):

R. Michael Scott ◽

Patrick Barnes ◽

William Kupsky ◽

Lester S. Adelman

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Vascular Malformations ◽

Cavernous Angioma ◽

Neurological Status ◽

Pathological Examination ◽

Incomplete Resection ◽

Content Type ◽

Cavernous Angiomas ◽

The Central Nervous System

✓ A surgical series of 19 patients under the age of 18 years with pathologically verified cavernous angioma is presented. Most lesions were located in the cerebral hemispheres, but four were in the pons or midbrain, two in the diencephalon, and one in the spinal cord. Fourteen patients presented with an acute or progressing neurological deficit, three with seizures, one infant with irritability, and one with headache alone. Five patients had family histories of vascular malformations of the central nervous system, and five had multiple lesions. Surgery for small or deep lesions was aided considerably by intraoperative ultrasonographic or stereotactic localization techniques. Pathological examination of the resected malformations revealed a complex histology containing not only typical closely approximated cavernous vessels, but also areas of marked proliferation of granulation tissue and partially re-endothelialized hemorrhage, suggesting a mechanism for the apparent growth of certain cavernous angiomas. The postoperative results were good, with only one patient suffering a permanent worsening of neurological status after surgery. Incomplete resection was initially carried out in five patients, two of whom rebled within 1 year after operation. Long-term follow-up findings in these patients have emphasized the unusual history of certain of these malformations.

Download Full-text

Epileptic seizures due to multiple cerebral cavernomatosis

Vojnosanitetski pregled ◽

10.2298/vsp0707489s ◽

2007 ◽

Vol 64 (7) ◽

pp. 489-492

Author(s):

Mirjana Spasic ◽

Stevo Lukic

Keyword(s):

Vascular Malformations ◽

Neuropsychological Testing ◽

Epileptic Seizures ◽

Unprovoked Seizure ◽

Cavernous Angiomas ◽

Everyday Activities ◽

Epileptiform Discharges ◽

Baseline Activity ◽

Neuroradiological Examination ◽

Wide Awake

Background. Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4?0.9 % of people, and represent around 5% of all cerebrovascular malformations. They can be single or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. Ten to 30 % are associated with familial clustering. Case report. We presented the case of a 43-year-old man, admitted to the Emergency Department due to unprovoked seizure during the wide awake and everyday activities. Neurological examination was with no focal signs. A 32-channel standard digital EEG was without any significant changes of normal baseline activity. After sleep deprivation EEG showed multifocal, bilateral and asymmetric polyspikes and sharpwaves activity. Hyperventilation induced generalized epileptiform discharges. MRI scan demonstrated multiple small cavernous angiomas. Neuropsychological testing demonstrated a delayed memory impairment. Neurosurgery treatment was not recommended, and the therapy with valproate 1 250 mg/day had an excellent efficacy with no singnificant adverse effects. Conclusion. This patient considered as a rare case with multiple cavernomatosis highlights the importance of neuroradiological examination in adult patients with the first epileptic seizure but with no focal neurological signs. .

Download Full-text

Utility of preoperative functional magnetic resonance imaging for identifying language cortices in patients with vascular malformations

Journal of Neurosurgery ◽

10.3171/jns.2002.97.1.0021 ◽

2002 ◽

Vol 97 (1) ◽

pp. 21-32 ◽

Cited By ~ 94

Author(s):

Nader Pouratian ◽

Susan Y. Bookheimer ◽

David E. Rex ◽

Neil A. Martin ◽

Arthur W. Toga

Keyword(s):

Magnetic Resonance ◽

Sensitivity And Specificity ◽

Sentence Comprehension ◽

Vascular Malformations ◽

Visual Object ◽

Functional Magnetic Resonance ◽

Content Type ◽

Cavernous Angiomas ◽

Matching Criteria ◽

Fine Print

Object. The goal of this study was to evaluate the utility of preoperative functional magnetic resonance (fMR) imaging in the prediction of whether a given cortical area would be deemed essential for language processing by electrocortical stimulation mapping (ESM). Methods. The authors studied patients with vascular malformations, specifically arteriovenous malformations (AVMs) and cavernous angiomas, in whom blood-flow patterns are not normal and in whom a perfusion-dependent mapping signal may be questionable. Ten patients were studied (seven harboring AVMs and three with cavernous angiomas). The authors used a battery of linguistic tasks, including visual object naming, word generation, auditory responsive naming, visual responsive naming, and sentence comprehension, to identify brain regions that were consistently activated across expression and comprehension linguistic tasks. In a comparison of ESM and fMR imaging activations, the authors varied the matching criteria (overlapping activations, adjacent activations, and deep activations) and the radii of influence of ESM (2.5, 5, and 10 mm) to determine the effects of these factors on the sensitivity and specificity of fMR imaging. The sensitivity and specificity of fMR imaging were dependent on the task, lobe, and matching criterion. For the population studied, the sensitivity and specificity of fMR imaging activations during expressive linguistic tasks were found to be up to 100 and 66.7%, respectively, in the frontal lobe, and during comprehension linguistic tasks up to 96.2 and 69.8%, respectively, in the temporal and parietal lobes. The sensitivity and specificity of each disease population (patients with AVMs and those with cavernous angiomas) and of individuals were consistent with those values reported for the entire population studied. Conclusions. The authors conclude that preoperative fMR imaging is a highly sensitive preoperative planning tool for the identification of which cortical areas are essential for language and that this imaging modality may play a future role in presurgical planning for patients with vascular malformations.

Download Full-text