Management of incidental cavernous malformations: a review

2011 ◽  
Vol 31 (6) ◽  
pp. E5 ◽  
Author(s):  
Richard T. Dalyai ◽  
George Ghobrial ◽  
Issam Awad ◽  
Stavropoula Tjoumakaris ◽  
L. Fernando Gonzalez ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Vascular Malformations ◽  
Imaging Techniques ◽  
Therapeutic Interventions ◽  
Neurological Deficits ◽  
Optimal Management ◽  
Review Of The Literature ◽  
Cavernous Malformations ◽  
Concise Review ◽  
Symptomatic Intracranial Hemorrhage

Cavernous malformations (CMs) are angiographically occult vascular malformations that are frequently found incidentally on MR imaging. Despite this benign presentation, these lesions could cause symptomatic intracranial hemorrhage, seizures, and focal neurological deficits. Cavernomas can be managed conservatively with neuroimaging studies, surgically with lesion removal, or with radiosurgery. Considering recent studies examining the CM's natural history, imaging techniques, and possible therapeutic interventions, the authors provide a concise review of the literature and discuss the optimal management of incidental CMs.

scholarly journals Emerging clinical imaging techniques for cerebral cavernous malformations: a systematic review

2010 ◽  
Vol 29 (3) ◽  
pp. E6 ◽  
Author(s):  
Peter G. Campbell ◽  
Pascal Jabbour ◽  
Sanjay Yadla ◽  
Issam A. Awad
Keyword(s):  
Mr Imaging ◽  
Diffusion Tensor ◽  
Imaging Techniques ◽  
Cerebral Cavernous Malformations ◽  
Advanced Imaging ◽  
Clinical Imaging ◽  
Cavernous Malformations ◽  
Concise Review ◽  
Intraoperative Management ◽  
Functional Mr Imaging

Cerebral cavernous malformations (CCMs) are divided into sporadic and familial forms. For clinical imaging, T2-weighted gradient-echo sequences have been shown to be more sensitive than conventional sequences. Recently more advanced imaging techniques such as high-field and susceptibility-weighted MR imaging have been employed for the evaluation of CCMs. Furthermore, diffusion tensor imaging and functional MR imaging have been applied to the preoperative and intraoperative management of these lesions. In this paper, the authors attempt to provide a concise review of the emerging imaging methods used in the clinical diagnosis and treatment of CCMs.

scholarly journals Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Nikolaos Mouchtouris ◽  
Nohra Chalouhi ◽  
Ameet Chitale ◽  
Robert M. Starke ◽  
Stavropoula I. Tjoumakaris ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Vascular Malformations ◽  
Imaging Techniques ◽  
Neurological Deficits ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Microsurgical Resection ◽  
Different Characteristics ◽  
The Brain ◽  
Methods Of Treatment

Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.

scholarly journals Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 127
Author(s):  
Francesca Gabriela Paslaru ◽  
Anca Maria Panaitescu ◽  
Elena Nestian ◽  
George Iancu ◽  
Alina Veduta ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Imaging Techniques ◽  
Diagnostic Procedures ◽  
Intracranial Tumor ◽  
Neurological Deficits ◽  
Physiological Changes ◽  
Intracranial Tumors ◽  
Review Of The Literature ◽  
Common Complaint ◽  
Persistent Headache

Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms—persistent headache followed by neurological deficit—in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.

Coexistence of intracranial and spinal cavernous malformations: a study of prevalence and natural history

2006 ◽  
Vol 104 (3) ◽  
pp. 376-381 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Jeffrey T. Jacob ◽  
Diane A. Edwards ◽  
William E. Krauss
Keyword(s):  
Family History ◽  
Natural History ◽  
Mr Imaging ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Recurrent Hemorrhage ◽  
Long Term Follow Up ◽  
History Of ◽  
Clinically Significant

Object The purpose of this study was to examine the prevalence of intracranial cavernous malformations (CMs) in a large series of predominantly Caucasian patients with spinal cord CMs. The authors also studied the natural history of spinal CMs in patients who were treated nonoperatively. Methods The medical records of 67 consecutive patients (32 female and 35 male patients) in whom a spinal CM was diagnosed between 1994 and 2002 were reviewed. The patients’ mean age at presentation was 50 years (range 13–82 years). Twenty-five patients underwent resection of the lesion. Forty-two patients in whom the spinal CM was diagnosed using magnetic resonance (MR) imaging were followed expectantly. Thirty-three (49%) of 67 patients underwent both spinal and intracranial MR imaging. All available imaging studies were reviewed to determine the coexistence of an intracranial CM. Fourteen (42%) of the 33 patients with spinal CMs who underwent intracranial MR imaging harbored at least one cerebral CM in addition to the spinal lesion. Six (43%) of these 14 patients did not have a known family history of CM. Data obtained during the long-term follow-up period (mean 9.7 years, total of 319 patient-years) were available for 33 of the 42 patients with a spinal CM who did not undergo surgery. Five symptomatic lesional hemorrhages (neurological events), four of which were documented on neuroimaging studies, occurred during the follow-up period, for an overall event rate of 1.6% per patient per year. No patient experienced clinically significant neurological deficits due to recurrent hemorrhage. Conclusions As many as 40% of patients with a spinal CM may harbor a similar intracranial lesion, and approximately 40% of patients with coexisting spinal and intracranial CMs may have the nonfamilial (sporadic) form of the disease. Patients with symptomatic spinal CMs who are treated nonoperatively may have a small risk of clinically significant recurrent hemorrhage. The findings will aid in evaluation of surveillance images and in counseling of patients with spinal CMs, irrespective of family history.

scholarly journals Surgical management of congenital thoracic kyphosis and multilevel bilateral thoracic pedicle aplasia: case report

2019 ◽  
Vol 23 (1) ◽  
pp. 16-21
Author(s):  
Darryl Lau ◽  
Cecilia L. Dalle Ore ◽  
Kenneth W. Martin ◽  
James F. Policy ◽  
Peter P. Sun
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Thoracic Kyphosis ◽  
Neurological Deficits ◽  
Spinal Deformities ◽  
Optimal Management ◽  
Review Of The Literature ◽  
Vertebral Level ◽  
Multiple Levels ◽  
Severe Spinal Deformities

Pedicle aplasia is an uncommon congenital anomaly most frequently involving the absence of a single pedicle at a single vertebral level. Bilateral pedicle aplasia at multiple levels is exceedingly rare and has only been described once previously in the literature. While single-level pedicle aplasia is often asymptomatic and discovered incidentally, pedicle aplasia of multiple levels may produce severe spinal deformities and neurological deficits. Due to the rarity of this condition, optimal management remains uncertain. In this case report, the authors describe the surgical management of a healthy 9-year-old boy who presented with frequent falls, difficulty running, and severe thoracic kyphotic deformity and was found to have bilateral pedicle aplasia from T3 to T9. A review of the literature regarding pedicle aplasia is also presented.

scholarly journals Cerebral cavernous malformation in a patient with pontine hemorrhage: A case study

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Myrto Palkopoulou ◽  
Eleni Bakola ◽  
Marina Foliadi ◽  
Petros Stefanidis ◽  
P. Teresa Acquaviva
Keyword(s):  
Magnetic Resonance ◽  
Medical History ◽  
Intracranial Hemorrhage ◽  
De Novo ◽  
Vascular Malformations ◽  
Magnetic Resonance Tomography ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Vascular Walls ◽  
Pontine Hemorrhage

The cerebral cavernous malformations are benign vascular hamartomas, with thin and dilated vascular walls and therefore constantly susceptible to hemorrhage. Clinically, they present with recurrent headaches, acute intracranial hemorrhage and focal neurological deficits. They are considered as angiographically occult vascular malformations and the imaging technique of choice for their diagnosis is magnetic resonance tomography. We present the case of a female patient with acute-onset symptomatology, congruent with a lesion in the basal pons. Her medical history included an intracranial hemorrhage due to a cavernoma, which was surgically removed. The magnetic resonance imaging of the brain revealed two new cavernomas, which were not identified in the imaging conducted in the past. In literature, the cases of de novo appearance of cavernomas are considered highly rare, especially in patients with no consistent family history or medical history of radiation therapy. Resultantly, they should be considered as dynamic lesions, regarding their number, size and behavior.

An analysis of the natural history of cavernous angiomas

1991 ◽  
Vol 75 (5) ◽  
pp. 702-708 ◽  
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.

Stereotactic radiosurgery for symptomatic solitary cerebral cavernous malformations considered high risk for resection

2010 ◽  
Vol 113 (1) ◽  
pp. 23-29 ◽  
Author(s):  
L. Dade Lunsford ◽  
Aftab A. Khan ◽  
Ajay Niranjan ◽  
Hideyuki Kano ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Brain Structures ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Cerebral Cavernous Malformations ◽  
Safe Procedure ◽  
Cavernous Malformations ◽  
Risk Of Hemorrhage

Object A retrospective study was conducted to reassess the benefit and safety of stereotactic radiosurgery (SRS) in patients with solitary cerebral cavernous malformations (CCMs) that bleed repeatedly and are poor candidates for surgical removal. Methods Between 1988 and 2005 at the University of Pittsburgh, the authors performed SRS in 103 evaluable patients (57 males and 46 females) with solitary symptomatic CCMs. The mean patient age was 39.3 years. Ninety-eight percent of these patients had experienced 2 or more hemorrhages associated with new neurological deficits. Seventeen patients (16.5%) had undergone attempted resection before radiosurgery. Ninety-three CCMs were located in deep brain structures and 10 were in subcortical lobar areas of functional brain importance. The median malformation volume was 1.31 ml, and the median tumor margin dose was 16 Gy. Results The follow-up ranged from 2 to 20 years. The annual hemorrhage rate—that is, a new neurological deficit associated with imaging evidence of a new hemorrhage—before SRS was 32.5%. After SRS 22 hemorrhages were observed within 2 years (10.8% annual hemorrhage rate) and 4 hemorrhages were observed after 2 years (1.06% annual hemorrhage rate). The risk of hemorrhage from a CCM was significantly reduced after radiosurgery (p < 0.0001). Overall, new neurological deficits due to adverse radiation effects following SRS developed in 14 patients (13.5%), with most occurring early in our experience. Modifications in technique (treatment volume within the T2-weighted MR imaging–defined margin, use of MR imaging, and dose reduction for CCM in critical brainstem locations) further reduced risks after SRS. Conclusions Data in this study provide further evidence that SRS is a relatively safe procedure that reduces the rebleeding rate for CCMs located in high-surgical-risk areas of the brain.

Stereotactic radiosurgery of cavernous malformations

2000 ◽  
Vol 93 (6) ◽  
pp. 987-991 ◽  
Author(s):  
Bruce E. Pollock ◽  
Yolanda I. Garces ◽  
Scott L. Stafford ◽  
Robert L. Foote ◽  
Paula J. Schomberg ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Mr Imaging ◽  
Stereotactic Radiosurgery ◽  
Lesion Size ◽  
Neurological Deficits ◽  
Morbidity Rate ◽  
Cavernous Malformations ◽  
Content Type ◽  
Latency Interval ◽  
Fine Print

Object. The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years.Methods. Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months.The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long—repetition time MR imaging performed a median of 8 months (range 5–16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02).Conclusions. It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.

scholarly journals Brainstem cavernous malformations: a review with two case reports

2009 ◽  
Vol 67 (3b) ◽  
pp. 917-921 ◽  
Author(s):  
Adolfo Ramírez-Zamora ◽  
José Biller
Keyword(s):  
Radiation Therapy ◽  
De Novo ◽  
Vascular Malformations ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Pregnant Patient ◽  
Complex Nature ◽  
Cavernous Malformations ◽  
Symptomatic Intracranial Hemorrhage ◽  
Brainstem Cavernous Malformation

Central nervous system (CNS) cavernous malformations (CMs) are developmental malformations of the vascular bed with a highly variable clinical course due to their dynamic nature. We present one case of "de novo" brainstem cavernous malformation after radiation therapy adding to the increasing number of reported cases in the medical literature, and the case of a pregnant patient with symptomatic intracranial hemorrhage related to brainstem CMs to illustrate the complex nature in management of these patients, followed by a review of clinical and radiographic characteristics. CMs account for 8-15% of all intracranial and intraspinal vascular malformations. Although traditionally thought to be congenital in origin, CMs may present as acquired lesions particularly after intracranial radiation therapy. Clinical manifestations are protean and surgical treatment should be considered for patients with progressive neurologic deficits.

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