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El-Ghandour NMF. Commentary: Interhemispheric Contralateral Transcallosal Approach to a Giant Thalamic Cavernous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2025; 28:582-583. [PMID: 39162410 DOI: 10.1227/ons.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024] Open
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2
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Akramov OZ, Nazarova LA, Kurbanov FM, Tashmatov SA, Rakhimov II, Usmankhanov OA, Chaurasia B. Giant cerebellar cavernous malformation in children: A case report and literature review. J Cerebrovasc Endovasc Neurosurg 2024; 26:304-310. [PMID: 38213114 PMCID: PMC11449536 DOI: 10.7461/jcen.2024.e2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
Giant cerebellar cavernomas in children are rare and must be differentiated from hemorrhagic cerebellar tumors. The diagnosis and treatment of giant cerebellar cavernomas is challenging, but complete surgical resection can lead to favorable outcomes and complete neurological recovery in most cases. We present a case of eight months old baby who was diagnosed with a giant cavernoma resulting in secondary obstructive hydrocephalus with neuropsychiatric presentations. The patient underwent a paramedian craniotomy surgery with a suboccipital approach and complete surgical resection of the cavernoma was done. Over nine months of observation, the child showed improvement in their ability to walk and fully recovered from a neurological perspective. We also conducted a literature review to identify eleven cases of giant cerebellar cavernomas in children, including our case. The data were analyzed to determine the clinical features, treatment, and outcomes of giant cerebellar cavernomas in children.
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Affiliation(s)
- Olim Zaribovich Akramov
- Department of Neurosurgery, National Children’s Medical Center, Ministry of Healthcare of Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Lilia Aleksandrovna Nazarova
- Department of Neurosurgery, National Children’s Medical Center, Ministry of Healthcare of Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Fuat Mukadasavoch Kurbanov
- Department of Neurosurgery, National Children’s Medical Center, Ministry of Healthcare of Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Sukhrob Abdurashibovich Tashmatov
- Department of Neurosurgery, National Children’s Medical Center, Ministry of Healthcare of Republic of Uzbekistan, Tashkent, Uzbekistan
| | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Moreno I, Scalia G, Umana GE, Soriano C, Alcivar I, Chaurasia B. Giant cerebral cavernous malformation in a newborn: a rare case report and review of literature. Childs Nerv Syst 2024; 40:2215-2221. [PMID: 38607549 DOI: 10.1007/s00381-024-06401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Cavernous malformations (CMs), also known as cavernomas or cavernous angiomas, are vascular malformations characterized by sinusoidal spaces lined by endothelial cells. Giant CMs (GCMs) are extremely rare, with limited understanding of their presentation and management. We present a case of symptomatic GCM in a newborn and review the literature on this rare entity. CASE DESCRIPTION A 1-month-old newborn presented with focal seizures and signs of increased intracranial pressure. Imaging revealed a massive right frontal-parietal GCM, prompting surgical resection. Histopathological examination confirmed the diagnosis of cerebral cavernous malformation. The patient recovered well postoperatively with no neurological deficits. CONCLUSIONS GCMs are exceedingly rare in children and have not been reported in newborns until now. Symptoms typically include seizures and mass effects. Gross total resection is the standard treatment, offering favorable outcomes. Further research is needed to understand the natural history and optimal management of GCMs, particularly in newborns, emphasizing the importance of heightened clinical awareness for timely diagnosis and appropriate management.
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Affiliation(s)
- Ismael Moreno
- Department of Pediatric Neurosurgery, Hospital del Niño Francisco Icaza Bustamante, Guayaquil, Ecuador
| | - Gianluca Scalia
- Department of Neurosurgery, Garibaldi Hospital, Catania, Italy
| | | | - Ciro Soriano
- Department of Pediatric, Hospital Del Niño Francisco Icaza Bustamante, Guayaquil, Ecuador
| | - Isis Alcivar
- Department of Pediatric, Hospital Del Niño Francisco Icaza Bustamante, Guayaquil, Ecuador
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Demir MK, Kılıc D, Zorlu E, Kılıc T. Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics. Indian J Radiol Imaging 2024; 34:511-521. [PMID: 38912256 PMCID: PMC11188748 DOI: 10.1055/s-0044-1779587] [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: 06/25/2024] Open
Abstract
Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions. Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive. Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult. Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.
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Affiliation(s)
- Mustafa Kemal Demir
- Clinic of Radiology, Bahcesehir University Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Deniz Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Emre Zorlu
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
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Finger G, Zimelewicz Oberman D, Loyola Godoy B, de Miranda Chaves Christiani M, Aversa A. Microsurgical Resection of Giant Radio-Induced Cavernous Malformation: 2- Dimensional Video. World Neurosurg 2024; 184:42-43. [PMID: 38218441 DOI: 10.1016/j.wneu.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Radioinduced cavernous malformations (RICMs) are low-flow, angiographically occult vascular lesions. Giant radioinduced cavernous malformations (GRICMs) are a subtype of RICMs that are characterized by their large size. GRICMs are defined as RICMs that are larger than 3 cm in diameter.1 They are uncommon conditions accounting for 0.1% to 0.5% among patients who have received radiation therapy for head and neck cancer or brain tumors.2,3 The risk of developing GRICMs increases with the dose of radiation received and the length of time since radiation exposure.4 Other factors that may increase the risk of developing GRICMs include age, genetic predisposition, and underlying medical conditions.5 Due to the relatively low incidence of GRICMs and the limited number of studies on this condition, there are limited data about the management of this condition. This case report describes a 12-year-old female who was previously treated for a pilocytic astrocytoma in 2012. After undergoing stereotactic biopsy and whole-brain radiotherapy (50 gray in 28 sections), she was diagnosed with a radioinduced cavernous malformation in 2016 during follow-up imaging. The RICM was managed conservatively with imaging follow-up, which showed no increase in size between 2016 and 2019. However, in 2020, the patient experienced a seizure episode associated with left-sided hemiplegia. Further investigation with cranial magnetic resonance imaging and digital subtraction angiography showed a mixed-intensity image and surrounded by a low signal intensity rim on T2-weighted images, representing hemosiderin in the right central lobe, with intense perilesional edema, with no enhancement. Given the size and location of the mass, the patient underwent microsurgical resection of the RICM (Video 1). The surgery was successful, and the lesion was successfully resected. This case highlights the importance of careful monitoring for RICMs in patients who have received radiation therapy, as well as the potential for these lesions to cause significant symptoms and disability. The case also demonstrates that surgical intervention may be necessary in some cases to manage RICMs and that microsurgical resection can be an effective treatment option. The patient gave informed consent for surgery and video recording.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Bruno Loyola Godoy
- Department of Neurosurgery, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | - Antonio Aversa
- Department of Neurosurgery, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
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González-Gallardo E, Rauschenbach L, Santos AN, Riess C, Li Y, Tippelt S, Della Marina A, Dohna-Schwake C, Sure U, Dammann P. Giant Cavernous Malformation Mimicking an Infiltrative Intracranial Neoplasm in Children-Case Report and Systematic Review of the Literature. World Neurosurg 2023; 174:30-41. [PMID: 36889633 DOI: 10.1016/j.wneu.2023.02.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Giant cavernous malformations (GCMs) are rare and poorly characterized neurovascular lesions in adults or children and often misclassified. In this study, we provide a review of pediatric GCM cases to highlight this rare entity as an important differential diagnosis in preoperative assessment. METHODS We report a pediatric case of GCM that presented as an intracerebral, periventricular, and infiltrative mass lesion. We performed a systematic review of published literature describing cases of GCM in children using the PubMed, Embase, and Cochrane Library databases. Studies describing cerebral or spinal cavernous malformation >4 cm were included. Demographic, clinical, radiographic, and outcome data were extracted. RESULTS Thirty-eight studies accounting for 61 patients were reviewed. most patients were 1-10 years old and 55.73% were male. Average lesion sizes ranged between 4 and 6 cm (40.98% >6 cm; 8.19% >10 cm). Supratentorial localization was most common (75.40%), with frontal and parieto-occipital regions being frequent localizations. Infratentorial lesions (24.60%) were located within the cerebellum (16.39%) and brainstem (8.19%). One case of spinal cavernoma was found. The main clinical manifestations were seizures (44.26%), focal neurologic deficit (36.06%), and headache (22.95%). Imaging showed contrast enhancement (36.06%), cystic features (27.86%), and infiltrative growth pattern (4.91%). CONCLUSIONS GCMs show variable clinical and radiologic features, representing a diagnostic challenge for treating surgeons. Imaging may show various tumorlike features such as cystic or infiltrative patterns with contrast enhancement. The existence of GCM should be considered preoperatively. Gross total resection should be attempted whenever possible, because it correlates with a good recovery and long-term outcomes. Also, a clear definition criteria of when a cerebral cavernous malformation is termed giant should be established.
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Affiliation(s)
- Enrique González-Gallardo
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany.
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Christoph Riess
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Stephan Tippelt
- Department of Pediatrics, University Hospital Essen, Essen, Germany
| | | | | | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
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Irsyad MA, Fitra F, Sanjaya FA, Suroto NS, Al Fauzi A. Cerebellar cavernoma excision with a preserved venous anomaly: A case report in girl 28-year-old. Int J Surg Case Rep 2023; 107:108332. [PMID: 37269764 DOI: 10.1016/j.ijscr.2023.108332] [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: 02/28/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cavernous malformations are congenital or acquired vascular abnormalities. They are uncommon entities with an incidence of 0.5 % of the general population and usually are unnoticed until a hemorrhagic event occurs. Cerebellar cavernomas (CCMs) account for 1.2 to 11.8 % of all intracranial cases and 9.3 to 52.9 % of all infratentorial cases. Cavernomas can be concurrently seen with developmental venous anomalies (DVAs) in 20 % (range 20 %-40 %) of cases, in which case they are known as mixed vascular malformations. PRESENTATION OF CASE We report a case of a healthy young adult who presented with acute onset of headache, with characteristics of chronic headache that gets progressively worse. The patient complains of frequent dizziness when sitting and standing for a long time. Complaints have been felt for two years and have worsened for the past two weeks. Additional complaints are dizziness and nausea with intermittent episodes of vomiting for four days. Magnetic resonance imaging (MRI) revealed an underlying cavernoma that had bled and a coexisting DVA. The patient was discharged home with no deficits. Outpatient follow-up two months later showed no symptoms or neurologic deficits. CLINICAL DISCUSSION Cavernous malformations are congenital or acquired vascular anomalies that occur in approximately 0.5 % of the general population. Our patient likely had dizziness due to localization of the bleeding of the cavernoma on the left side of the cerebellum. In our patient, brain imaging revealed numerous abnormal blood vessels radiating from the cerebellar lesion, a highly suggestive of DVAs associated with cavernoma. CONCLUSION A cavernous malformation is an uncommon entity that might coexist with deep venous anomalies, making management more challenging.
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Affiliation(s)
- Muhammad Ari Irsyad
- Universitas Sumatera Utara Hospital, Medan, Indonesia; Department of Neurosurgery, H. Adam Malik General Hospital, Medan, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Fitra Fitra
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Firman Adi Sanjaya
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Blambangan Hospital, Banyuwangi, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Sandoval Ramírez CJ, Salazar Ramírez ZE, Abdo Toro MA, García López R, González Zavala PA, Estrada Estrada EM, Cruz Rosales JL, Rodríguez Florido MA. Case series of giant Cavernomas: Clinical presentation and management recommendations. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Suyasha R, Saujanya R, Pranaya S, Pravesh R, Basant P. Cavernoma presenting with an atypical clinico-radiological finding: A case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gilbert OE, Wilson JM, Volk JM. Giant Frontotemporal Cavernous Malformation in a 2-Month-Old Infant: A Case Report and Review of the Literature. Pediatr Neurosurg 2022; 57:56-62. [PMID: 34749375 DOI: 10.1159/000519856] [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: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cavernous malformations in the pediatric population are exceedingly rare, especially in infants. Giant cavernous malformations (GCM) are even more rare and have a diameter >4 cm. The onset of symptoms predominantly occurs in adulthood, but the rate of hemorrhage is significantly higher in the pediatric population. Similar to non-GCM, GCM can be misidentified as tumors on imaging due to their tumefactive pattern with edema. Here, we present a rare case of a right frontotemporal GCM in a 2-month-old girl, the youngest recorded case in the existing literature. CASE PRESENTATION A previously healthy 2-month-old girl presented to the emergency department following an increasing frequency of seizure-like activity that began 3 days prior to presentation. Magnetic resonance imaging of the brain with and without contrast characterized a large (5.8 × 4.3 × 4.2 cm) heterogeneous lesion of the right temporal lobe with diffuse scattered blood products of various ages seen throughout the lesion. She underwent a right-sided craniotomy where a gross total excision was achieved. Pathology confirmed the diagnoses of a GCM. The patient's seizures subsequently resolved, and she continues to do well postoperatively. DISCUSSION/CONCLUSION GCM can be mistaken for tumors due to their large size, cystic nature, and surrounding edema, but a vascular lesion should always remain in the differential diagnosis before operating, even in infants. Surgery is generally recommended in patients that present with a symptomatic hemorrhage, recurrent hemorrhages, persistent seizures despite medical management, or progressively worsening neurological deficits if the GCM is in a safe location. It has been shown that 70-99% of patients undergoing surgery with successful removal of the GCM can achieve seizure freedom 2 years postoperatively. Complete surgical excision of this infant's GCM was successful in treating her neurologic symptoms; therefore, pathological confirmation of this lesion is critical and should prompt a complete surgical excision.
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Affiliation(s)
- Olivia E Gilbert
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA,
| | - John M Wilson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jerome M Volk
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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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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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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Gaddi MJS, Pascual JSG, Legaspi EDC, Rivera PP, Omar AT. Giant Cerebellar Cavernomas in Pediatric Patients: Systematic Review with Illustrative Case. J Stroke Cerebrovasc Dis 2020; 29:105264. [PMID: 33066939 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Giant cavernomas (GCMs) are angiographically occult vascular malformations of the central nervous system measuring at least 4 cm in diameter. These are rare lesions, especially in the cerebellum. As such, the clinical and radiologic features, surgical management, and outcomes of treatment for this condition are unknown. METHODS We performed a systematic review of SCOPUS and PubMed databases for case reports and case series of histopathologically proven GCMs arising from the cerebellum in the pediatric population, and included a case managed at our center. Data on clinical presentation, imaging features, surgical treatment and outcomes of management were collected. RESULTS A total of 10 cases were identified from the systematic review, including our case report. The patients' median age was 6 months, with a slight male sex predilection (1.5:1). The most common neurologic manifestations were bulging fontanelle in infants, and headache and focal cerebellar deficits in older children. Surgical excision was done in all cases, while 50% of the cases had CSF diversion surgery done prior to excision. In cases with reported outcome, complete neurologic recovery was achieved in seven while partial recovery was reported in one case. No deaths were reported at median follow-up of 12 months. CONCLUSION Our case report and systematic review show that giant cerebellar cavernoma is a rare differential diagnosis for symptomatic hemorrhagic cerebellar masses in the pediatric age group. Mainstay of treatment is surgical excision, which can be associated with favorable outcome in most cases.
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Affiliation(s)
- Mairre James S Gaddi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Eric Dennis C Legaspi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Peter P Rivera
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Abdelsimar T Omar
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Manila, Philippines.
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Grujić J, Jovanović V, Tasić G, Savić A, Stojiljković A, Matić S, Lepić M, Rotim K, Rasulić L. GIANT CAVERNOUS MALFORMATION WITH UNUSUALLY AGGRESSIVE CLINICAL COURSE: A CASE REPORT. Acta Clin Croat 2020; 59:183-187. [PMID: 32724292 PMCID: PMC7382876 DOI: 10.20471/acc.2020.59.01.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Giant cavernomas (GC) are rare lesions, with less than 50 cases reported so far. Clinical presentation usually involves epileptic seizures and less typically focal neurological deficit, due to repeated hemorrhages and GC mass effect and consequentially increased intracranial pressure. Although individual cases have been reported, due to the rarity and variable imaging appearance, GCs are usually not considered in the differential diagnosis of large hemorrhagic lesions, especially when significant mass effect is present. A 17-year-old boy presented due to severe headache, right-sided weakness, and slurred speech. Symptoms started three days before with occasional headaches, which intensified gradually. Emergency computed tomography revealed a left frontal massive heterogeneous lesion. Soon after, right-sided hemiparesis and speech impairment progressed, and the patient became drowsy with the slightly dilated left pupil. Emergency surgery was performed, and the lobed grayish lesion was entirely removed. Based on the macroscopic appearance, the surgeon assumed it was a metastasis of melanoma. Histopathologic analysis result was cavernoma. GC should be considered as an option in hemorrhagic lesions, especially in the young age population. Emergency surgery for mass lesions is not uncommon in neurosurgery; however, bleeding cavernomas are usually planned for elective surgery due to the specific approach and complications.
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Affiliation(s)
| | - Vladimir Jovanović
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Goran Tasić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Andrija Savić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Aleksandra Stojiljković
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Siniša Matić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Milan Lepić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Krešimir Rotim
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Lukas Rasulić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 4School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
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Eng-Chuan S, Kritsaneepaiboon S, Kaewborisutsakul A, Kanjanapradit K. Giant intraventricular and paraventricular cavernous malformations with multifocal subependymal cavernous malformations in pediatric patients: Two case reports. World J Radiol 2020. [DOI: 10.4329/wjr.v12.i2.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Eng-Chuan S, Kritsaneepaiboon S, Kaewborisutsakul A, Kanjanapradit K. Giant intraventricular and paraventricular cavernous malformations with multifocal subependymal cavernous malformations in pediatric patients: Two case reports. World J Radiol 2020; 12:10-17. [PMID: 32180903 PMCID: PMC7061262 DOI: 10.4329/wjr.v12.i2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Giant cavernous malformation (GCM) is rarely found in intraventricular or paraventricular locations.
CASE SUMMARY We present two cases of 6-mo and 21-mo boys with intraventricular and paraventricular GCMs including a literature review focused on location and imaging findings. Characteristic magnetic resonance imaging findings such as multicystic lesions and a hemosiderin ring or bubbles-of-blood appearance can assist in the differential diagnosis of a hemorrhagic intraventricular and/or paraventricular mass.
CONCLUSION Multifocal intraventricular and/or paraventricular GCM in small children is rare. The characteristic magnetic resonance imaging findings can help to differentiate GCMs from other intraventricular tumors.
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Affiliation(s)
- Suwadee Eng-Chuan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Anukoon Kaewborisutsakul
- Neurosugery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
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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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Lan Z, Richard SA, Li J, Xu J, You C. A giant solid cavernous hemangioma mimicking sphenoid wing meningioma in an adolescent: A case report. Medicine (Baltimore) 2018; 97:e13098. [PMID: 30383694 PMCID: PMC6221700 DOI: 10.1097/md.0000000000013098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Central nervous system (CNS) solid cavernous hemangiomas are rare extra-axial anomalies that may sometimes resemble meningiomas. Due to their complex vascular nature, accurate preoperative diagnosis is important to avoid disastrous hemorrhage during operation. To the best of our knowledge this is the first case in an adolescent since all middle cranial fossa hemangioma cases reported in literature are adults in their 40s or 50s and all the pediatric cases are cystic. PATIENT CONCERNS We present a case of a 14-year-old girl with headache and dizziness for 3 months. She occasionally experienced nausea and vomiting but denied visual disturbances and loss of smell. DIAGNOSES MRI revealed a lesion that extends to the greater wing of the sphenoid bone as well as the pituitary fossa. Our initial diagnosis was a sphenoid wing meningioma but interestingly, histopathology revealed solid cavernous hemangioma. INTERVENTIONS The residual tumor was completely removed with 2 sessions of Gamma Knife radiotherapy after surgery. OUTCOMES We were confronted with excessive bleeding during surgery so we attained subtotal resection. However, the patient recovered well with no recurrence of the tumor. LESSONS Our case shows that space occupying lesions involving the cavernous sinus and sphenoid ridged could be easily misdiagnosed as sphenoid wing meningiomas in children and adolescents and even adults therefore great care must be exercised when confronted with this kind of presentation.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
- Department of Surgery, Volta Regional Hospital, Ghana, West Africa
| | - Jin Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
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20
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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: 13] [Impact Index Per Article: 1.9] [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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21
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Villaseñor-Ledezma J, Budke M, Alvarez-Salgado JA, Cañizares MA, Moreno L, Villarejo F. Pediatric cerebellar giant cavernous malformation: case report and review of literature. Childs Nerv Syst 2017; 33:2187-2191. [PMID: 28744689 DOI: 10.1007/s00381-017-3550-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND IMPORTANCE Giant cavernous malformations (GCM) are low flow, angiographically occult vascular lesions, with a diameter >4 cm. Cerebellar GCMs are extremely rare, with only seven cases reported based on English literature. These lesions are most commonly seen in the pediatric age group, which is known to have an increased risk of hemorrhage, being surgery clearly recommended. CLINICAL PRESENTATION An 18-month-old girl presented with a 6-month history of cervical torticollis and upper extremities clumsiness. An MRI revealed a 57 × 46 × 42 mm multi-cystic, left cerebellar hemisphere mass, showing areas of hemorrhages and cysts with various stages of thrombus. There was no enhancement with contrast. Cerebral angiography ruled out an arteriovenous malformation. She underwent a left paramedian occipital craniotomy, and macroscopic gross total resection was accomplished. Histopathologic examination was consistent with a cavernous malformation. After surgery, the patient had no new neurological deficit and an uneventful postoperative recovery. Follow-up MRI confirmed total removal of the lesion. CONCLUSION Cerebellar GCMs in children are symptomatic lesions, which prompt immediate surgical treatment. These are rare lesions, which can radiologically and clinically mimic a tumor with bleed, having to be considered in the differential diagnosis of neoplastic lesions. Cerebellar GCMs might be suspected in the presence of large hemorrhagic intra-axial mass with "bubbles of blood," multi-cystic appearance, surrounded by hemosiderin ring, fluid-fluid levels, and accompanying edema-mass effect. Careful radiological study provides a preoperative diagnosis, but its confirmation requires histopathological examination. Complete surgical removal should be attempted when possible.
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Affiliation(s)
| | - Marcelo Budke
- Department of Neurosurgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - María-Angeles Cañizares
- Department of Neurosurgery, Complejo Hospitalario de Toledo, Ave. Barber 30, 45005, Toledo, Spain
| | - Luis Moreno
- Department of Neurosurgery, Complejo Hospitalario de Toledo, Ave. Barber 30, 45005, Toledo, Spain
| | - Francisco Villarejo
- Department of Neurosurgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Hirata K, Ihara S, Sato M, Matsumaru Y, Yamamoto T. Hyper-vascular giant cavernous malformation in a child: a case report and review. Childs Nerv Syst 2017; 33:375-379. [PMID: 27585994 DOI: 10.1007/s00381-016-3234-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Giant cavernous malformation (GCM) in children is a rare vascular anomaly, and its natural history is unclear. Despite their giant size, intraparenchymal GCMs are low-flow vascular malformations. Herein, we report a case of hyper-vascular intraparenchymal GCM with an AV shunt in a child. CASE A 3-year-old boy had had an enlarged head since infancy. Magnetic resonance (MR) images on admission showed a strikingly enhanced mass lesion, 6 cm in size. A 4-vessel CAG demonstrated a hyper-vascular mass with an AV shunt. After transarterial embolization, the patient underwent total excision of the mass. The tumor bled easily, during surgery the patient lost 400 cm3 in blood. Histopathological examination confirmed the diagnosis of cavernous hemangioma. CONCLUSION The differential diagnosis of intraparenchymal, strikingly-enhanced tumors with an AV shunt include hyper-vascular GCMs. Consideration of potential for bleeding during the operation is also important.
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Affiliation(s)
- Koji Hirata
- Department of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musahidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Satoshi Ihara
- Department of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musahidai, Fuchu, Tokyo, 183-8561, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, University of Tsukuba Hospital, Ibaraki, Japan
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23
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Sarbu N, Pujol T, Oleaga L. Hyperintense perilesional edema in the brain on T1-weighted images: Cavernous malformation or metastatic melanoma? Three case reports and literature review. Neuroradiol J 2016; 29:52-6. [PMID: 26838172 DOI: 10.1177/1971400915626430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hyperintense perilesional edema in brain masses on T1-weighted images (T1WI) is an unusual radiological finding. We report three cases showing this particular type of edema, one representing cerebral hemorrhagic cavernous malformation (CCM, cavernoma) and the other two, metastases of melanoma. The association between this sign and cavernoma was recently recognized. On the other hand, in melanotic lesions, the relationship with T1WI-hyperintense perilesional edema has not yet been described. Despite being an infrequent sign, it can considerably narrow the differential diagnosis, which gives it a high value for clinical practice. Moreover, given the high prevalence of the entities that manifest this imaging feature, it can be occasionally noticed.
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Affiliation(s)
- Nicolae Sarbu
- Clinique de Neuroradiologie, Erasme University Hospital, Cliniques Universitaires de Bruxelles, ULB, Belgium
| | - Teresa Pujol
- Neuroradiology Department, Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Laura Oleaga
- Neuroradiology Department, Hospital Clínic Barcelona, University of Barcelona, Spain
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Wu H, Yu T, Wang S, Zhao J, Zhao Y. Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases. World Neurosurg 2015; 84:1103-11. [PMID: 26070634 DOI: 10.1016/j.wneu.2015.05.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The goal of this study was to discuss the surgical indications, surgical approaches, and prognostic factors of cerebellar cavernous malformation (CM). METHODS We retrospectively reviewed the presentation, surgery, and outcome of 58 consecutive patients who underwent resection of cerebellar CMs between 2009 and 2013 in our center. RESULTS The study population consisted of 31 males and 27 females, mean age 39.9 years. Fifty-eight patients experienced 67 symptomatic hemorrhages. The median diameter of all lesions was 2.2 ± 0.9 cm (range, 0.8-4.8 cm). The locations were classified into 3 groups: group 1, cerebellar hemisphere (17 cases, 29.3%); group 2, vermis (18 cases, 31.0%); and group 3, cerebellar peduncle (23 cases, 39.7%). Complete resection was achieved in all patients without surgical mortality. Postoperatively, 11 patients developed new surgical complications, including facial paralysis in 6 patients, ataxia in 2 patients, dizziness in 2 patients, and decrease in facial sensation in 1 patient. The mean modified Rankin Scale (mRS) at final follow-up was significantly improved compared with the preoperative score (0.5 ± 0.5 vs. 1.4 ± 0.7, P = 0.035). The symptoms and neurologic deficits improved in most patients. The lesion location was the only factor that predicted a worse outcome, and the mRS was significantly lower in group 3 than groups 1 and group 2 (P = 0.019). CONCLUSIONS Patients with cerebellar CMs usually achieve favorable outcomes via surgery. Cerebellar peduncle CMs cause significantly more neurologic deficits than other locations. A reasonable surgical approach and meticulous manipulation are necessary to prevent impairment of neurologic function.
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Affiliation(s)
- Hongji Wu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China; Department of Neurosurgery, Baoding No. 1 Central Hospital, Hebei, People's Republic of China
| | - Tao Yu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China.
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Mohindra S, Sodhi HS, Rane S. Tumefactive presentation of a supratentorial cavernous hemangioma: A report of two cases. J Pediatr Neurosci 2014; 8:232-4. [PMID: 24470821 PMCID: PMC3888044 DOI: 10.4103/1817-1745.123689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study reports two children, including a 2-month-old infant, harboring giant cavernous hemangiomas (GCH) in the supratentorial compartment, causing raised intracranial pressure and focal deficits. Relevant demographic details, clinical presentation, and radiological findings of GCH are discussed in light of tumefactive presentation. Differential diagnoses of such radiological findings are elaborated.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimratbir Singh Sodhi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnil Rane
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim IC, Kwon KY, Rhee JJ, Lee JW, Hur JW, Lee HK. Giant cystic cerebral cavernous malformation with multiple calcification - case report. J Cerebrovasc Endovasc Neurosurg 2013; 15:255-9. [PMID: 24167810 PMCID: PMC3804668 DOI: 10.7461/jcen.2013.15.3.255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/16/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022] Open
Abstract
Cerebral cavernous malformation with giant cysts is rare and literature descriptions of its clinical features are few. In this case study, the authors describe the clinical symptoms, radiological findings, and pathological diagnosis of cerebral cavernous malformations with giant cysts, reviewing the relevant literature to clearly differentiate this from other disease entities. The authors present a case of a 19-year-old male with a giant cystic cavernous malformation, who was referred to the division of neurosurgery due to right sided motor weakness (grade II/II). Imaging revealed a large homogenous cystic mass, 7.2×4.6×6 cm in size, in the left fronto-parietal lobe and basal ganglia. The mass had an intra-cystic lesion, abutting the basal portion of the mass. The initial diagnosis considered this mass a glioma or infection. A left frontal craniotomy was performed, followed by a transcortical approach to resect the mass. Total removal was accomplished without post-operative complications. An open biopsy and a histopathological exam diagnosed the mass as a giant cystic cavernous malformation. Imaging appearances of giant cavernous malformations may vary. The clinical features, radiological features, and management of giant cavernous malformations are described based on pertinent literature review.
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Affiliation(s)
- Il-Chun Kim
- Department of Neurosurgery, Cheongju St. Mary's hospital, Cheongju, Korea
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Giant cerebellar cavernous malformation in 4-month-old boy. Case report and review of the literature. Neurol Neurochir Pol 2013; 47:596-600. [DOI: 10.5114/ninp.2013.39078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cortés Vela J, Concepción Aramendía L, Ballenilla Marco F, Gallego León J, González-Spínola San Gil J. Cerebral cavernous malformations: Spectrum of neuroradiological findings. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cortés Vela JJ, Concepción Aramendía L, Ballenilla Marco F, Gallego León JI, González-Spínola San Gil J. Cerebral cavernous malformations: spectrum of neuroradiological findings. RADIOLOGIA 2011; 54:401-9. [PMID: 22197483 DOI: 10.1016/j.rx.2011.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 09/13/2011] [Accepted: 09/18/2011] [Indexed: 10/14/2022]
Abstract
Cavernous malformations (cavernomas) are hamartomatous lesions formed by sinusoidal vascular spaces, with no cerebral parenchyma between them. Seizures are the most usual clinical presentation. They are dynamic lesions, producing changes throughout their evolution. The majority are located in the supratentorial region, but up to 20% of cases they are found in the posterior fossa. In computed tomography (CT) and in magnetic resonance (MR) their typical presentation is as a well defined round or oval lesion, with or without a minimal mass effect or oedema, with little or no contrast enhancement. Their appearance in MRI will depend on the stage of the haemorrhage, a T2 echo gradient being the most sensitive sequence. Angiography do not usually detect cavernomas. However, it may demonstrate a venous developmental anomaly. Cavernomas may present with atypical characteristics, as regards their size, appearance, location and number.
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Affiliation(s)
- J J Cortés Vela
- Servicio de Radiodiagnóstico, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
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Spontaneous bleeding into a suprasellar cavernous angioma of a neonate: case report and literature review. Childs Nerv Syst 2011; 27:303-11. [PMID: 20419304 DOI: 10.1007/s00381-010-1161-7] [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] [Received: 03/27/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cavernous angiomas (CA) are congenital intraparenchymal vascular malformations that contain sinusoidal spaces lined by a single-layer endothelium, separated by collagenous stroma with no intervening brain parenchyma. Despite the congenital origin of CA, they rarely present in the neonatal and prenatal period. In this paper, we present a case report of a neonatal suprasellar CA that presented with a bleed. We also present a literature review focusing on specific features of intracranial CA in the neonatal and fetal age groups. CASE REPORT A 27-day-old neonate presented with a left eye ptosis for 2 days, followed by a generalized seizure. A head computed tomography revealed a suprasellar hematoma with intraventricular and subarachnoid extension. Brain magnetic resonance imaging revealed hemorrhages of various ages. Magnetic resonance angiography did not reveal any vascular malformation. Surgical exploration of the suprasellar mass revealed a capsulated dense hematoma. Postoperatively, the neonate was weaned of artificial ventilation over a protracted period and remained hemiparetic with signs of third nerve palsy. Pathology revealed a CA. CA presenting as a suprasellar bleed with subarachnoid and intraventricular extension is very rare especially among neonates. To the best of our knowledge, 20 cases of CA have been reported in the neonatal and fetal period in the English literature. Neonatal CA in general and suprasellar location in particular are extremely rare lesions. Neonatal/fetal CA seems to present more aggressively and have a worse prognosis compared to those presenting at a later age.
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Thakar S, Furtado SV, Ghosal N, Hegde AS. A peri-trigonal giant tumefactive cavernous malformation: case report and review of literature. Childs Nerv Syst 2010; 26:1819-23. [PMID: 20665038 DOI: 10.1007/s00381-010-1237-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Giant cavernous malformations (GCMs) constitute an uncommon entity in the diagnostic armamentarium of the neurosurgeon. We report a 3-year-old boy with a GCM in the peri-trigonal region and review 13 other paediatric cases previously reported in literature. CASE A 3-year-old boy presented with right-sided hemiparesis and features of raised intracranial pressure of short duration. Computed tomography showed a large left peri-trigonal mass with a bleed. Magnetic resonance imaging showed associated perilesional edema and mass effect, rendering the lesion a tumefactive appearance. He underwent total excision of the lesion, with subsequent recovery of hemiparesis. Histopathology was reported as a cavernoma. DISCUSSION The clinico-radiological presentation of GCM is discussed based on a case report and relevant cases in literature. Good surgical outcome can be expected with total microsurgical excision. CONCLUSION A giant cavernous malformation should be one of the differentials of a lesion with a tumefactive clinico-radiological presentation in children. There should be a high index of suspicion for such a diagnosis, especially when the lesion does not enhance with contrast. This is the third case report in paediatric literature describing a periventricular location of this unusual lesion.
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Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.
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Ozgen B, Senocak E, Oguz KK, Soylemezoglu F, Akalan N. Radiological features of childhood giant cavernous malformations. Neuroradiology 2010; 53:283-9. [PMID: 21046093 DOI: 10.1007/s00234-010-0783-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/13/2010] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Giant cavernous malformations (GCM) are very large, low-flow vascular malformations, which usually have atypical imaging features and are commonly misdiagnosed preoperatively as neoplasms or vascular malformations. These lesions have mostly been reported in children. As cavernomas show different features in children compared to adults, we evaluated the imaging features of pediatric GCMs in order to help in the preoperative diagnosis of these malformations. METHODS Brain MR studies of nine children (mean age of 4 years; 8 months-9 years) with biopsy-proven GCM were retrospectively evaluated. We defined GCMs as cavernomas of ≥4 cm. Lesions were evaluated regarding their size, location, signal characteristics, general appearance (uni/multilocular) as well as regarding the presence of mass effect, edema, and fluid-fluid levels and were classified according to the Mottolese classification of pediatric cavernomas. RESULTS Lesion locations were parietal (n = 5), frontal (n = 2), temporal, and intraventricular. Seven lesions were in the periventricular region (with five in the periatrial region). Six patients had T1 hyperintense multilobulated lesions with "bubbles of blood" appearance and three patients had heterogeneous lesions with reticular core. All lesions had mass effect, edema (marked in four cases), and peripheral hemosiderin rim. Fluid-fluid levels were also common (n = 7). Most of our lesions (six of nine) were classified as type IIIA, two as type IIIC, and one as type IA. CONCLUSION In children, a GCM should be considered in case of very large hemorrhagic intra-axial mass with "bubbles of blood" multicystic appearance, surrounding hemosiderin ring, fluid-fluid levels, and accompanying edema-mass effect, especially in the periatrial location.
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Affiliation(s)
- Burce Ozgen
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.
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Muccio CF, Catapano G, Di Blasi A, Esposito G, Cerase A. Giant cystic intraventricular cerebral cavernous malformation: MRI with pathologic correlation. A case report. Neuroradiol J 2008; 21:547-50. [PMID: 24256962 DOI: 10.1177/197140090802100413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 05/11/2008] [Indexed: 11/17/2022] Open
Abstract
The purpose of this case report is to increase awareness of the spectrum of cerebral cavernous malformations (CCMs). We report the MRI findings and histological features of an uncommon case of a single giant (maximum diameter: >6 cm) cystic CCM of the left lateral ventricle occurring in a 26-year-old man who had undergone 30 Gy cranial irradiation for acute leukemia at the age of six years. Large cystic CCMs must be included in the neuroradiological differential diagnosis of intraventricular hemorrhagic cystic lesions.
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Affiliation(s)
- C F Muccio
- Neuroradiology Unit, Department of Neurosciences, "G. Rummo" Hospital; Benevento, Italy -
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