Related Experiment Videos
[Four cases of cerebral venous angioma--with special reference to its surgical indication and CT diagnosis]
Insights
This study reports four cases of venous angioma, detailing surgical and non-surgical management of cerebral and cerebellar lesions. Outcomes varied, highlighting the complexity of treating these vascular malformations.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Venous angiomas are congenital vascular malformations characterized by abnormal venous development.
- These lesions can occur in the brain and cerebellum, potentially leading to neurological symptoms or hemorrhage.
Purpose of the Study:
- To report four cases of venous angioma, including cerebral and cerebellar locations.
- To describe the clinical presentation, diagnostic imaging, and management strategies employed.
Main Methods:
- Case series involving four patients diagnosed with venous angioma.
- Diagnostic modalities included computed tomography (CT) scans and cerebral angiography.
- Treatment approaches encompassed surgical resection and conservative management.
Main Results:
- One cerebral venous angioma with a hematoma required craniotomy, evacuation, and partial resection, resulting in temporary neurological decline and eventual recovery.
- Three cerebellar venous angiomas were identified; one with a hematoma underwent suboccipital craniectomy and electrocoagulation with an uneventful recovery.
- Two cerebellar venous angiomas without hemorrhage were managed conservatively with successful outcomes.
Conclusions:
- Venous angiomas present with diverse clinical manifestations, ranging from hemorrhage to non-hemorrhagic symptoms like vertigo and headache.
- Management strategies should be individualized based on lesion location, presence of hemorrhage, and clinical presentation.
- Surgical intervention for symptomatic or hemorrhagic venous angiomas can be effective but carries risks, while conservative management is suitable for asymptomatic cases.
Abstract:
Four cases of venous angioma, one cerebral and three in the cerebellum, are reported. Case 1. A 50-year-old woman who had a sudden attack of headache and disorientation was admitted to the Mitsui Memorial Hospital. Neurological examination revealed slight disorientation, mild motor aphasis and right hemiparesis. Plain CT scan on admission showed a left frontal hematoma. Left cerebral angiomas demonstrated a caput-Medusae-like lesion which consisted of numerous small veins and drained into one single enlarged vein. Enhanced CT scan taken 12 days after the attack demonstrated a linear enhancement next ot the hematoma. Left frontal craniotomy was performed, and the hematoma was evacuated. In the next step, coagulation and resection of the major part of the angioma was attempted. However, this caused significant swelling of the adjacent brain and the angioma had to be resected totally including intervening normal cerebral tissue. Postoperatively, the patient became worse with significant hemiparesis and severe motor aphasia. After intensive rehabilitation treatment, she recovered gradually and was discharged on foot with moderate speech disturbances. Histological examination revealed a typical venous angioma with hyalinization of vessel wall. Case 2. A 55-year-old woman with a 9 year history of vertigo and headache was admitted to our hospital because of sudden onset of numbness in her right lower limb. Enhanced CT scan revealed a small nodular high density lesion and an old hematoma in the right cerebellar hemisphere. Vertebral angiograms demonstrated a single abnormal vein with some small veins in the right cerebellum. Right suboccipital craniectomy was performed and the blood clot was removed. The abnormal veins were electro-coagulated. The postoperative course was uneventful and the patient was discharged with no neurological deficit. Case 3. A 31-year-old man was admitted to our department with 9 month history of nausea and vertigo attack. Enhanced CT scan demonstrated a large nodular high density lesion in the left cerebellar hemisphere. Vertebral angiograms showed a typical caput-Medusae-like venous angioma. The patient had no evidence of hemorrhage and was discharged without surgery. Case 4. A 36-year-old man who had two attacks of nausea and headache was admitted to the Mitsui Memorial Hospital. Enhanced CT scan showed a linear high density lesion in the right cerebellar hemisphere. Vertebral angiograms disclosed a typical venous angioma in the right cerebellum. This patient also had no attack of bleeding and was discharged without operation.(ABSTRACT TRUNCATED AT 250 WORDS)