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Updated: Apr 20, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Third ventricle cavernous malformations: Diagnostic pitfalls and optimal surgical strategies - Scoping review with
Simona Serioli1, Beatrice Zucca2, Silvia Seguini3
1Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy; Technology for Health PhD Program, University of Brescia, Brescia 25124, Italy.
Objective:
Third ventricle cerebral cavernous malformations (TV-CCMs) are rare lesions. They are often misdiagnosed due to imaging overlap with other TV pathologies. Moreover, they appear to exhibit more aggressive behaviour than parenchymal CCMs. The goal of this study is to evaluate diagnostic errors, the therapeutic options (conservative management vs surgery) chosen and their related outcomes.
Methods:
The PRISMA-ScR (1980-2025), combined with an institutional case series, analyzes diagnostic accuracy, bleeding risk, and surgical outcomes. Literature scoping review (42 studies) and 3 institutional cases yielded 67 TV-CCMs patients.
Results:
Misdiagnosis occurred in 23.9% (n = 16/67) of cases, primarily due to absent GRE/SWI sequences (85.1% cases, 57/67). Surgery was first-line option in 85.1% (n = 57/67, GTR: 73.7%, n = 43/57), yielding 89.5% (n = 51/57) good outcomes (mRS 0-2). Conservative management had a 50% rebleeding rate (5/10); non-surgical first-line treatments (radiotherapy and CSF diversion) were linked to all deaths (6.0%, n = 4/67). Fisher's Exact Test showed surgical superiority (OR 0.204, p = 0.00015), though limited by case report bias.
Conclusion:
TV-CCMs, often misdiagnosed due to the absence of GRE/SWI sequences, present a high risk rebleeding risk, confirming the superiority of surgery over nonsurgical approaches (rebleeding 1.8% vs. 50%), with macroscopically total resection achieved in 73.7% of cases and excellent outcomes. These findings support early surgical intervention, a routine diagnostic protocol (3 T MRI + mandatory GRE/SWI sequences), and proactive management of this high-risk entity.
