Intracranial cavernous hemangiomas: neuroradiologic review of 36 operated cases

Neuroradiologic studies in 36 cases of histologically verified intracranial cavernous hemangiomas were reviewed. Radionuclide brain scans were positive in 17 of 19 examinations. Angiography, performed in 35 cases, usually showed an avascular area with absent or moderate mass effect. Capillary blush and/or early draining veins, often mentioned in single case reports, were observed in only seven cases. Computed tomography (18 cases) usually demonstrated a hyperdense, nodular, or irregular lesion without significant mass effect and always enhancing after contrast injection. The combination of a long clinical history of focal epilepsy with computed tomographic and angiographic findings should suggest the diagnosis of cavernous hemangioma. In all cases of so-called spontaneous hematoma with negative angiography, computed tomography should be repeated after a long interval to exclude the presence of a cavernous hemangioma or other cryptic vascular malformation.