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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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Shroff K, Deopujari C, Karmarkar V, Mohanty C. Paediatric giant cavernomas: report of three cases with a review of the literature. Childs Nerv Syst 2021; 37:3835-3845. [PMID: 34247276 DOI: 10.1007/s00381-021-05286-6] [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: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cavernous angiomas of the brain (CCM) are being increasingly diagnosed, especially in the paediatric age group. Though classic presentations with haemorrhage or seizures are well recognised, presentation as a large lesion with mass effect is rare and creates difficulty in diagnosis as well as management. METHODS Our cases of paediatric giant CCMs that presented as a 'mass lesion' are reported here, and the PubMed database for giant CCMs in the paediatric population is reviewed. All articles where the size of the lesion was reported to be > 4 cm were selected for analysis to study the varying modes of presentation, treatment, and outcome; to gain a proper perspective on this distinct entity of 'giant CCMs'. RESULTS Analysis of a total of 53 cases (inclusive of our 3 cases) reported so far showed slight male preponderance (58.49%). The largest reported lesion was 14 cm in largest diameter. Most of the lesions (83.02%) occurred in the supratentorial region. In the infratentorial region, paediatric giant CCMs were more commonly seen in the cerebellum than in the brainstem. Seizures were observed in 47.17% at presentation. Features of mass effect were the mode of presentation in all our cases, and literature analysis has shown raised intracranial pressure in 37.74% (20 patients) and focal neurological deficit in 33.96% (18 patients) at presentation. Macrocephaly was seen in younger children up to the age of 7 years (16.98% or 9 patients). Gross total resection was carried out (with a good outcome) in all our cases and in 36 of the other 49 analysed patients who were operated on. DISCUSSION About one-fourth of CCMs occur in paediatric patients. Giant CCMs are rare but can present in children even in the immediate post-natal period. Features of a mass lesion such as raised intracranial pressure, macrocephaly, and focal neurological deficit are much more common than their smaller counterparts. Their appearance on imaging also often causes diagnostic dilemmas with other intracranial mass lesions. Timely surgery with standard microsurgical principles leads to a favourable outcome in the majority. CONCLUSION Giant CCMs, though rare, often present as a diagnostic challenge. Presentation with mass effect is common, and complete microsurgical excision remains the mainstay of treatment. Though transient neurological deficits may be encountered with this strategy, the long-term outcome remains favourable.
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Affiliation(s)
- Krishna Shroff
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020.
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
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Pongeluppi RI, de Souza SNF, Neder L, Furlanetti L, Colli BO, Ballestero MFM, de Oliveira RS. Adult giant cerebellar cavernous malformations: case report and review of the literature. Br J Neurosurg 2021; 37:1-6. [PMID: 34406083 DOI: 10.1080/02688697.2021.1961685] [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: 01/13/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Cavernous malformations are vascular malformations that can occur anywhere in the central nervous system (CNS). Giant cavernous malformations (GCM) are extremely rare in adults, especially in the posterior fossa. Herein, we described a 48-year-old male who presented with vertigo and postural instability for three months. Neuroimaging revealed a 131.15 cm3 heterogeneous midline upper cerebellar lesion. After a suboccipital craniotomy, a gross total resection (GTR) was accomplished. Histopathologic examination revealed a huge cavernous malformation. Only 27 GCM adult cases were reported in the English-based literature. Only two patients had cerebellar lesions and, to the best of our knowledge, this is the first case of cerebellar vermis GCM. We concluded that cerebellar GCM (CGCM) in adults are exceedingly rare and indolent lesions. These lesions can radiologically and clinically mimic neoplastic lesions that have to be considered in the differential diagnosis. GTR is the mainstay of treatment and, whenever possible, should be attempted.
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Affiliation(s)
- Rodrigo Inácio Pongeluppi
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Stephanie Naomi Funo de Souza
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Luciano Neder
- Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Luciano Furlanetti
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Fernando Manzolli Ballestero
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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Rangnekar RD, Vilanilam GC, Krishnakumar K, Abraham M. Giant Cavernomas: Gigantic Propositions for a Lilliputian Problem? Neurol India 2021; 69:153-156. [PMID: 33642289 DOI: 10.4103/0028-3886.310114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The aim of this case series is to report two cases of giant cavernomas treated at a tertiary level centre along with a literature review on the differences between giant cavernomas and normal sized cavernomas. Method The first case was that of a 13-year-old male with habitual seizures since one year of age with normal examination findings. His imaging revealed a large parieto-occipital lesion which was excised microsurgically after a parieto-occipital craniotomy and a transcortical approach. The second case was a 26-year-old male who presented with generalised seizures and bilateral visual loss. Imaging was suggestive of a large left lateral ventricular lesion. A left fronto-temporo-parietal craniotomy was done followed by transventricular microsurgical excision. Histopathology of both cases were reported to be cavernomas. The first patient had transient hemiparesis post-operatively which improved within 24 hours. Eventually, both patients had an uneventful follow-up. Conclusion Microsurgical excision remains the treatment of choice for giant cavernomas. In toto excision may be advocated depending upon the location of the cavernoma especially with respect to eloquence and venous anatomy.
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Affiliation(s)
- Ranjit D Rangnekar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - George C Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K Krishnakumar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Wang Z, Hu J, Wang C. Rare asymptomatic giant cerebral cavernous malformation in adults: two case reports and a literature review. J Int Med Res 2021; 48:300060520926371. [PMID: 33307903 PMCID: PMC7739106 DOI: 10.1177/0300060520926371] [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: 11/15/2022] Open
Abstract
Cavernous malformations are benign vascular malformations. Giant cavernous malformations are very rare. All reported cases have been symptomatic because of the large size and compression of the surrounding brain tissue. We report two asymptomatic cases of giant cavernous malformation that were both misdiagnosed as neoplasms because of their atypical presentations. The first case was a 54-year-old man whose computed tomography and magnetic resonance imaging scans revealed an inhomogeneous lesion of 6 cm diameter and mild enhancement in the left frontal lobe. A left lateral supraorbital and transcortical approach was applied and the lesion was completely removed. The second case was a 36-year-old man with an irregular large mass in the parasellar region. Craniopharyngioma was suspected and gross total resection was performed. Post-surgical pathological analyses confirmed the diagnoses as cavernous malformations. Both patients recovered uneventfully. The rare asymptomatic giant cavernous malformations reported here in adults had benign behavior for this specific disease entity. The different clinical characteristics of ordinary cavernous malformation and adult and pediatric giant cavernous malformation imply complex and distinct genetic backgrounds. Concerns should be raised when considering giant cavernous malformation as a differential diagnosis for atypical large lesions. Surgical resection is recommended as the primary treatment option.
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Affiliation(s)
- Zhen Wang
- Department of Neurosurgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junwen Hu
- Department of Neurosurgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chun Wang
- Department of Neurosurgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Clinical-radiological correlations in a de novo cavernous angioma with pseudotumour-like behaviour. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Correlato clínico-radiológico de un angioma cavernoso de novo con comportamiento seudotumoral. RADIOLOGIA 2020; 62:243-247. [DOI: 10.1016/j.rx.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
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Hassani FD, Karekezi C, El Abbadi N. Rare case of giant pediatric cavernous angioma of the temporal lobe: A case report and review of the literature. Surg Neurol Int 2020; 11:7. [PMID: 31966926 PMCID: PMC6969371 DOI: 10.25259/sni_468_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Giant cavernous malformations of the central nervous system are quite rare. They are more common in children and may be misdiagnosed as other intracranial neoplasms. Here, we presented a very rare giant cavernous angioma mimicking a neoplastic temporal lobe lesion in an 18-month-old male. Case Description: An 18-month-old male presented with two initial seizures. Although the clinical examination was normal, the computed tomography (CT) scan showed a large left temporal mass (66 mm diameter) exerting significant mass effect and midline shift. The brain magnetic resonance (MR) imaging demonstrated a large left temporal heterogeneously enhancing lesion with significant perilesional edema and mass effect. The patient underwent gross total removal of the lesion that proved to be an intracranial cavernous angioma. Postoperatively, he did well, exhibiting no residual neurological deficit, and has remained lesion and seizure-free. Conclusion: This and 12 other cases in the literature focus on intracranial cavernous angiomas that could have been readily misdiagnosed as tumors. It confirms why obtaining appropriate preoperative MR and CT studies, followed by surgical intervention, is essential to confirm the correct underlying pathology and appropriately and optimally treat the patient.
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Affiliation(s)
- Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Claire Karekezi
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
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9
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Armas Melián K, Rodríguez Pons D, Díaz Romero R, Givica Pérez A, Centeno Haro M, Fernandez JJ. Giant cerebral cavernomas malformations. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Wang C, Zhao M, Wang J, Wang S, Zhang D, Zhao J. Giant cavernous malformations: A single center experience and literature review. J Clin Neurosci 2018; 56:108-113. [PMID: 29983331 DOI: 10.1016/j.jocn.2018.06.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022]
Abstract
Intracranial giant cavernous malformations (GCMs) are rarely reported because of their extremely low incidence. Knowledge of GCM is poor. The goals of this study were to analyze the epidemiological characteristics, clinical manifestations, radiological findings, microsurgical treatment, and neurological outcomes of GCMs. From January of 2003 to December 2016, nine GCM patients who underwent neurosurgical treatment at Beijing Tiantan Hospital were chosen for analysis and their records were reviewed. We also performed an exhaustive literature search and identified all previously reported GCMs. The study population consisted of three males and six females (mean age, 25.1 years). The mean diameter of the malformations was 6.7 cm (range, 6.0-8.4 cm). The most common clinical manifestations were the symptoms caused by mass effect. Radiologically, all GCMs showed mixed T1 and T2 signals; five of them exhibited minimal enhancement after contrast administration. Gross total resection was achieved in all patients without surgical mortality. Postoperatively, three patients developed new surgical complications, including left limbs weakness and left side paralysis. The mean follow-up period after diagnosis was 69.3 months (range, 16-149 months); five patients (55.6%) had achieved full recovery and the remaining four cases (44.4%) were improved to some extent. GCM is a rare subgroup of vascular malformations; it is more prone to occur in children and adolescents. Microsurgical resection should be the treatment of choice for GCMs, and despite their giant size, excellent surgical outcomes after total removal could be achieved.
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Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO. 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China.
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11
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Girard R, Khanna O, Shenkar R, Zhang L, Wu M, Jesselson M, Zeineddine HA, Gangal A, Fam MD, Gibson CC, Whitehead KJ, Li DY, Liao JK, Shi C, Awad IA. Peripheral plasma vitamin D and non-HDL cholesterol reflect the severity of cerebral cavernous malformation disease. Biomark Med 2016; 10:255-64. [PMID: 26861901 DOI: 10.2217/bmm.15.118] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM To correlate cerebral cavernous malformations (CCMs) disease aggressiveness with peripheral blood biomarkers hypothesized mechanistically. PATIENTS & METHODS A prospective case-control study enrolled 43 CCM patients, where 25-(OH) vitamin D, HDL and non-HDL cholesterol, CRP plasma levels and leukocyte ROCK activity were correlated with parameters of disease aggressiveness reflecting chronic and acute domains. RESULTS Patients with one or more features of chronically aggressive disease (early age at symptom onset, two or more symptomatic bleeds, high lesion burden) had significantly lower 25-(OH) vitamin D and non-HDL cholesterol levels in comparison to patients without these features. CONCLUSION Validation of these biomarkers and their potential treatment modulation may influence the clinical care of patients with CCM disease.
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Affiliation(s)
- Romuald Girard
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Omaditya Khanna
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Robert Shenkar
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Lingjiao Zhang
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Meijing Wu
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Michael Jesselson
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Hussein A Zeineddine
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Anupriya Gangal
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Maged D Fam
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | | | - Kevin J Whitehead
- Division of Cardiology & Department of Medicine at the University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Dean Y Li
- Division of Cardiology & Department of Medicine at the University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - James K Liao
- Section of Cardiology, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Changbin Shi
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Issam A Awad
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA
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Kim WH, Lim DJ, Choi JI, Ha SK, Kim SD, Kim SH. Unusual Presentation of Cerebral Cavernous Malformation. J Cerebrovasc Endovasc Neurosurg 2015; 17:257-62. [PMID: 26523262 PMCID: PMC4626352 DOI: 10.7461/jcen.2015.17.3.257] [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] [Received: 06/01/2015] [Revised: 08/02/2015] [Accepted: 08/23/2015] [Indexed: 11/23/2022] Open
Abstract
Cerebral cavernous malformations (CMs) are vascular malformations of the central nervous system, which can be detected in the absence of any clinical symptoms. Nodules and cysts with mixed signal intensity and a peripheral hemosiderin rim are considered brain magnetic resonance imaging (MRI) findings typical of CMs. A 48-year-old man was admitted to our hospital because of abnormal MRI findings without significant neurological symptoms. A cyst with an internal fluid-fluid level was found in the left basal ganglia on the initial brain MRI. We decided to observe the natural course of the asymptomatic lesion with serial MRI follow-up. On MRI at the 5-month follow-up, the cystic mass was enlarged and showed findings consistent with those of cystic CM. Surgical resection was performed and the pathological diagnosis was CM. Our experience suggests that the initial presentation of a CM can be a pure cyst and neurosurgeons should consider the likelihood of CMs in cases of cystic cerebral lesions with intracystic hemorrhage.
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Affiliation(s)
- Won-Hyung Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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13
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The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. J Craniofac Surg 2014; 25:2105-8. [PMID: 25304144 DOI: 10.1097/scs.0000000000001050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The objective of this study was to investigate the diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. A total of 63 patients (45 men and 18 women; mean age of 43 years with a range from 20 to 72 years) who suffered from traumatic bifrontal contusions between January 2007 and December 2012 were inspected. The clinical and imaging results were studied for all patients, and we found that swelling of the mesencephalon and a downward shift of the bilateral red nucleus were significant signs of central brain herniation in the image of magnetic resonance imaging. All patients were given a simultaneous bilateral craniotomy for balanced decompressive surgery. The Glasgow Outcome Scale was used to monitor the patients during the follow-up period, which lasted from 6 to 52 months with a mean of 22 months. At the termination of the follow-up period, the following Glasgow Outcome Scale scores were obtained: 14 patients scored 5 points, 22 patients scored 4 points, 7 patients scored 3 points, 13 patients scored 2 points, and 7 patients scored 1 point. Therefore, our study suggested that an early magnetic resonance imaging scan could result in a more timely diagnosis of central brain herniation, and simultaneous bilateral craniotomy was found to be one of the best treatments for central brain herniation to improve patient outcomes.
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14
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Nahed BV, Ferreira M, Babu MA, Terry AR, Walcott BP, Kahle KT, Smith ER. Dural scalp and intracranial hemangiomas causing hydrocephalus and venous sinus thrombosis in an infant. J Child Neurol 2011; 26:777-81. [PMID: 21325128 DOI: 10.1177/0883073810390694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cutaneous scalp hemangiomas may herald the presence of occult intracranial hemangiomas. A previously healthy 4-month-old girl presented with a bleeding scalp hemangioma, a bulging fontanel, and anemia. Magnetic resonance imaging (MRI) of the brain revealed hydrocephalus along with multiple intracranial hemangiomas. These lesions compressed the jugular foramina, resulting in venous sinus thrombosis involving the right transverse sinus, the left sigmoid sinus, and the torcular herophili. The patient had no family history of phakomatoses or other genetic abnormalities. A thrombophilia work-up result was unremarkable. The patient was treated with prednisolone (10 mg twice daily) and low molecular weight heparin (1 mg/kg/dose) twice daily. This treatment decreased the size of her cutaneous and intracranial hemangiomas and led to the resolution of her venous sinus thromboses and hydrocephalus. Innocuous scalp hemangioma in an infant may herald more concerning intracranial pathology, which can be treated effectively if diagnosed with appropriate imaging studies.
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Affiliation(s)
- Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ohba S, Shimizu K, Shibao S, Nakagawa T, Murakami H. Cystic cavernous angiomas. Neurosurg Rev 2010; 33:395-400. [DOI: 10.1007/s10143-010-0245-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 01/03/2010] [Accepted: 01/03/2010] [Indexed: 10/19/2022]
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16
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Colpan ME, Uckardesler L, Sekerci Z, Slavin K. De novo formation of cerebral cavernous malformation in a patient with intractable epilepsy: case report and review. J Neuroimaging 2009; 20:302-6. [PMID: 19226336 DOI: 10.1111/j.1552-6569.2009.00362.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM The exact origin and process of development of cerebral cavernous malformations (CCMs) is currently unknown. In this article, the authors present de novo CCM formation in a patient with intractable epilepsy and discuss the pathogenesis of CCM in light of several current theories. CASE DESCRIPTION A 34-year-old man presented with a 10-year history of intractable seizures. His neurological examination was normal, and the initial magnetic resonance imaging (MRI) was suggestive of right mesial temporal sclerosis (MTS). Follow-up MRI study showed development of CCM in the right frontal region. Subsequently, invasive monitoring revealed right temporal seizure source, prompting right temporal lobectomy that resulted in abolition of epilepsy. Histological diagnosis of CCM was confirmed after the lesion was removed in a separate surgery. The patient recovered to normal lifestyle without any complications. CONCLUSION This appears to be a first documented case of de novo CCM formation in the setting of intractable epilepsy with ipsilateral MTS. Since the possibility of lesion development cannot be ruled out based on clinical examination, updated imaging and thorough neurophysiological workup are needed for successful treatment of patients with intractable epilepsy.
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Affiliation(s)
- Mustafa Efkan Colpan
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA.
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17
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Son DW, Lee SW, Choi CH. Giant cavernous malformation : a case report and review of the literature. J Korean Neurosurg Soc 2008; 43:198-200. [PMID: 19096644 PMCID: PMC2588260 DOI: 10.3340/jkns.2008.43.4.198] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 04/07/2008] [Indexed: 12/12/2022] Open
Abstract
Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 x 5 x 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.
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Affiliation(s)
- Dong Wuk Son
- Department of Neurosurgery, Pusan National University, School of Medicine, Busan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University, School of Medicine, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Pusan National University, School of Medicine, Busan, Korea
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18
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Coincident Giant Cavernous Angioma and Large Middle Cerebral Artery Aneurysm. Radiol Case Rep 2008; 3:153. [PMID: 27303516 PMCID: PMC4896170 DOI: 10.2484/rcr.v3i2.153] [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: 12/02/2022] Open
Abstract
Cavernous angiomas although relatively common lesions rarely reach a large size. They have a well documented association with AVMs, capillary telangiectases and venous angiomas but are not specifically associated with intracerebral aneurysms. We present a case of what we believe to be the 4th largest reported giant cavernous angioma to present in adulthood. This cavernous angioma also happened to be associated with a large intracerebral aneurysm, an association not previously reported. The sometimes confusing nomenclature of cavernous angiomas and other similar vascular malformations is also discussed.
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Kan P, Tubay M, Osborn A, Blaser S, Couldwell WT. Radiographic features of tumefactive giant cavernous angiomas. Acta Neurochir (Wien) 2008; 150:49-55; discussion 55. [PMID: 18066488 DOI: 10.1007/s00701-007-1455-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 10/22/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND Giant cavernous angiomas (GCAs) are very rare, and imaging features of GCAs can be very different from those of typical cavernous angiomas (CAs), making them a diagnostic challenge. The purpose of the study was to evaluate the radiographic features of GCAs, with an emphasis on the differentiating features from neoplastic lesions. METHODS The neuroradiological findings of 18 patients who harbored a histologically verified GCA (CA of 4 cm or larger) were reviewed retrospectively. The magnetic resonance imaging (MRI) appearance, enhancement pattern, presence of edema or mass effect, size, and location of each lesion were recorded. When available, pertinent clinical information, including age, sex, and mode of presentation, was obtained. FINDINGS Seizures, neurologic deficits, hemorrhage, and hydrocephalus were the most common presenting symptoms. The lesions were hyperdense and nonenhancing on computed tomography with frequent calcifications. On MRI, the lesions most commonly had a multicystic appearance, representing blood of various ages, and multiple complete hemosiderin rings. GCAs can present in any location with associating edema and mass effect, giving them a tumefactive appearance. No developmental venous anomaly was observed with any lesion. CONCLUSIONS Most GCAs in our series presented as multicystic lesions with complete hemosiderin rings on MRI, giving a "bubbles of blood" appearance. Although this characteristic feature is helpful in the diagnosis of many cases of GCAs, the correct diagnosis in the remaining cases may not be apparent until histopathological evaluation of the specimen is made.
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Affiliation(s)
- P Kan
- Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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20
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Kim YJ, Kim JE, Kim NR, Kim HS. Imaging findings of giant cavernous malformation with a focal infiltrative pattern. Pediatr Radiol 2007; 37:1039-42. [PMID: 17661023 DOI: 10.1007/s00247-007-0553-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 06/01/2007] [Accepted: 06/14/2007] [Indexed: 10/23/2022]
Abstract
Giant cavernous malformations are rare. There are 17 cases reported in the literature, eight of them in children. Although cavernous malformations have typical imaging findings, the diagnosis of giant cavernous malformation can be challenging because of its large size and varied appearance. It can be more challenging when imaging reveals multilobular involvement and a focal infiltrative pattern mimicking malignancy. We report a case of a giant cavernous malformation with multilobular involvement and a focal infiltrative pattern.
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Affiliation(s)
- Yoo Jin Kim
- Department of Radiology, Gil Medical Center, Gachon University of Medicine and Science, 1198 Kuwol-Dong, Namdong-Gu, Incheon 405-220, South Korea
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21
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Korematsu K, Yoshioka S, Maruyama T, Nagai Y, Tsuji KI, Kuratsu JI. De novo appearance of cerebellar cavernous malformation in a patient with moyamoya disease: case report and review of the literature. Clin Neurol Neurosurg 2007; 109:708-12. [PMID: 17574735 DOI: 10.1016/j.clineuro.2007.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 04/26/2007] [Accepted: 04/29/2007] [Indexed: 10/23/2022]
Abstract
The authors report a case of cerebellar cavernous malformation associated with moyamoya disease. An adolescent male with moyamoya disease had undergone bilateral direct and indirect extracranial-intracranial anastomosis at 11 years of age, and the course had been uneventful until MRI detected the appearance of a cavernous malformation in the cerebellum 3 years later. The lesion had grown, bled, and caused headache and disturbance of consciousness 2 years after the initial detection. The cavernous malformation was removed surgically and pathologically verified. The patient has recovered without any neurological deficits. This is a quite rare case with cavernous malformation which appeared in a moyamoya disease patient. The association of the two different vascular disorders in a young patient may suggest the existence of some interaction in the pathogenesis of these diseases. Since cavernous malformations with a de novo appearance may grow and become clinically significant, careful observation is necessary.
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Affiliation(s)
- Kojiro Korematsu
- Department of Neurosurgery, Oita Prefectural Hospital, Bunyo 476, Oita 870-8511, Japan.
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22
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Iwai Y, Yamanaka K, Yoshimura M. Intracerebral Cavernous Malformation Induced by Radiosurgery-Case Report-. Neurol Med Chir (Tokyo) 2007; 47:171-3. [PMID: 17457021 DOI: 10.2176/nmc.47.171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 37-year-old man was treated for lung cancer by chemo-radiation therapy. Subsequently, magnetic resonance (MR) imaging identified a ring-enhanced lesion in the left temporal lobe. Gamma knife radiosurgery was performed under a diagnosis of brain metastasis. Nevertheless, MR imaging showed regrowth of the tumor 1 year later, so radiosurgery was repeated on the same lesion. Two years after the first radiosurgery, MR imaging revealed an irregularly enhanced lesion with increasing perifocal edema in the left temporal lobe. Emergency surgery was performed under a diagnosis of impending uncal herniation. The histological diagnosis was cavernous malformation. This case demonstrates that gamma knife radiosurgery can cause radiation-induced cavernous malformation.
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Affiliation(s)
- Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Japan
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23
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Shin M, Kawahara N, Maruyama K, Tago M, Ueki K, Kirino T. Risk of hemorrhage from an arteriovenous malformation confirmed to have been obliterated on angiography after stereotactic radiosurgery. J Neurosurg 2005; 102:842-6. [PMID: 15926707 DOI: 10.3171/jns.2005.102.5.0842] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Radiosurgery has been widely adopted for the treatment of cerebral arteriovenous malformations (AVMs) in which the practical endpoint is angiographic evidence of obliteration, presumed to be consistent with elimination of the risk of hemorrhage. To test this unverified assumption, the authors followed 236 radiosurgery-treated AVMs between 1 and 133 months (median 77 months) after angiographic evidence of obliteration.
Methods. Four patients experienced hemorrhage between 16 and 51 months after angiographic confirmation of AVM obliteration, and two underwent resection. The histological findings in these patients showed occlusion of the AVM by thickening of the intimal layer with dense hyalinization as well as a small amount of residual AVM vessels and a tiny vasculature. The risks of hemorrhage from these presumaby obliterated AVMs were 0.3% for the annual bleeding risk and 2.2% for the cumulative risk over 10 years. Continuous enhancement of the nidus on computerized tomography (CT) or magnetic resonance (MR) imaging was the only significant factor positively associated with hemorrhage in the statistical analysis (p = 0.0212).
Conclusions. Because the study was based on limited follow-up data, its significance for defining predictive features of hemorrhage after angiographic evidence of obliteration is still indeterminable. Nevertheless, disappearance of the AVM on angiography after radiosurgery does not always indicate total elimination of the disease, especially when CT or MR imaging continues to demonstrate an enhancing lesion. The authors therefore recommend continual follow up even after evidence of AVM obliteration on angiography.
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Affiliation(s)
- Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
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Murakami K, Umezawa K, Kaimori M, Nishijima M. Cavernous angioma presenting as epilepsy 13 years after initial diagnosis. J Clin Neurosci 2004; 11:430-2. [PMID: 15080966 DOI: 10.1016/j.jocn.2003.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 05/17/2003] [Indexed: 11/26/2022]
Abstract
A 22-year-old man presented with tonic-clonic seizure and was admitted to our hospital. He had suffered from frequent headaches, and had been diagnosed with a brain tumour on MRI 13 years ago. However, neither further examination nor follow-up neuroimaging study have been performed. Computed tomography and magnetic resonance imaging demonstrated an intraaxial tumor with granular calcification in the right frontal lobe, attached to the adjacent dura mater, which was enlarged compared with the lesion on CT 13 years before. The lesion was surgically excised through right frontal craniotomy. Histopathological analysis indicated cavernous angioma. In cavernous angioma in younger children, more aggressive surgical indications than in adults may be favorable both to prevent haemorrhagic complications and to confirm pathologic diagnosis.
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Affiliation(s)
- Kensuke Murakami
- Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-2-1 Higahshi-tsukurimichi, Aomori, Japan.
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