Three-dimensional time-of-flight MR-angiography and the surgical indication of brainstem cavernomas

This study was designed to assess the diagnostic value of 3D time-of-flight MR-angiography in cerebral cavernomas. In seven patients, nine out of ten cavernomas were removed by microsurgery. While MR-angiography demonstrated well branches of brain arteries adjacent to the lesions, no flow signal in the vascular malformations was observed. On the other hand, there was a high intensity signal induced by methaemoglobin in those three patients with brainstem cavernomas who had experienced a significant bleeding attack seven months prior to admission. It had a spotted appearance in MR-angiography with volumes of the largest spots around 1.8 cm3. It is suggested that this spot signal could be used as a path marker for the surgical approach in brainstem cavernomas.