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Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases
Marcelo Campos Moraes Amato1, João Flávio Gurjão Madureira, Ricardo Santos de Oliveira
1Division of Pediatric Neurosurgery of the Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto SP, Brazil. amato@neurocirurgia.com
Insights
Pediatric intracranial cavernous malformations (CM) presenting with seizures are effectively treated with microsurgical excision, leading to complete seizure freedom post-surgery. Careful consideration is advised for multiple or asymptomatic CM cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Clinical Neuroscience
Background:
- Intracranial cavernous malformations (CM) are vascular malformations that can cause significant neurological symptoms in children.
- Understanding the clinical presentation and surgical outcomes is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical presentation and treatment outcomes of pediatric intracranial cavernous malformations (CM).
- To assess the efficacy of surgical resection in pediatric patients with symptomatic CM.
Main Methods:
- Retrospective review of 30 pediatric patients (<18 years) undergoing surgery for CM between 1993 and 2011.
- Analysis of clinical data, including symptoms, CM location, number of lesions, surgical procedures, and follow-up outcomes.
Main Results:
- Seizures, headache, and focal neurological deficits were common presenting symptoms.
- Surgical resection was performed in 86.6% of patients, with a mean follow-up of 4.1 years.
- All 15 children with preoperative seizures became seizure-free after surgery.
Conclusions:
- Complete microsurgical excision is the preferred treatment for symptomatic solitary intracranial cavernous malformations.
- Treatment strategies for multiple or asymptomatic CM require careful consideration due to potential risks and benefits.
Objectives:
To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution.
Methods:
Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011.
Results:
The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery.
Conclusions:
For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.
