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Published on: October 20, 2017
Cerebral cavernous malformation presenting in childhood: a single-centered surgical experience of 29 cases
Ayfer Aslan1, Alp Özgün Börcek2, Harun Demirci3
1Department of Neurosurgery, Edremit State Hospital, Balıkesir, Turkey.
Insights
Surgical removal of pediatric cerebral cavernous malformations (CMs) leads to good outcomes and seizure control. Younger patients experience a higher frequency of hemorrhage from these benign brain vascular tumors.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Cerebral cavernous malformations (CMs) are vascular hamartomas in the central nervous system.
- While often asymptomatic, CMs can cause severe complications requiring surgical intervention.
Purpose of the Study:
- To evaluate surgical outcomes for pediatric cerebral CMs.
- To compare findings with existing literature on CM treatment.
Main Methods:
- Retrospective analysis of 29 pediatric patients operated for CMs between 2007 and 2016.
- Data collected included patient demographics, presenting symptoms, surgical approach, and follow-up outcomes.
Main Results:
- Total excision was achieved in all patients, with a mean follow-up of 27.3 months.
- Seizures, the most common symptom (51.7%), showed significant improvement post-surgery (66.6% seizure-free).
- Hemorrhage frequency was notably higher in younger patients (p=0.019).
Conclusions:
- Total resection of pediatric cerebral CMs is associated with favorable clinical outcomes and effective seizure control.
- Younger age is identified as a potential risk factor for CM hemorrhage.
Objectives:
Cerebral cavernous malformations (CMs) are benign vascular hamartomas of central nervous system. Although they are mostly asymptomatic, they may occasionally result in life-threatening complications leading to surgical treatment. The main goal is to evaluate the surgical outcomes of operated pediatric cerebral CMs in our clinic and compare our results with the literature.
Patients And Methods:
The data of 29 pediatric patients who were operated for cerebral CMs in our clinic between 2007 and 2016 were collected.
Results:
Of 29 patients, 13 were girls and 16 were boys, and the mean age at operation was 11.4 years (range from 2 to 17 years). Main symptoms at presentation were seizures (15 patients, 51.7 %), headache (12 patients, 41.3 %), and focal neurological deficits (4 patients, 13.7 %). The frequency of hemorrhage in CMs was significantly higher in younger patients (p = 0.019). Total excision was achieved in all patients. The mean follow-up period was 27.3 months (range from 12 to 97 months). New neurological deficit following surgery occurred in 1 patient (3.4 %) who completely recovered after 3 months. After surgery, 1 patient (3.4 %) has become free of preoperative deficit; while the rest (27 patients) remained in preoperative neurological status. Of 15 patients presented with seizures preoperatively, 10 patients (66.6 %) were seizure free (Engel Class 1), 4 (26.6 %) were "almost seizure free" (Engel Class 2) and one (6.6 %) experienced "worthwhile improvement" (Engel Class 3) at the last follow up visit. There was no mortality in our series.
Conclusion:
Although management of cerebral CMs in childhood is controversial, total resection ensures good clinical outcome and seizure control. In addition, age can be a predisposing factor for hemorrhage.
