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[Cerebral cavernomas--clinical aspects and therapy]
J Meixensberger1, E Hofmann, K Roosen
1Abteilung für Neuroradiologie, Universität Würzburg, Deutschland.
Insights
Cavernomas, or congenital cerebrovascular hamartomas, are vascular malformations affecting 0.4-0.5% of the population. Treatment involves microsurgical resection for symptomatic cases, with careful consideration for deep-seated lesions.
Area of Science:
- Neurology
- Vascular Malformations
- Neurosurgery
Context:
- Cavernomas are congenital cerebrovascular hamartomas.
- They are characterized by sinusoidal blood-filled spaces without distinct arterial feeders or draining veins.
- These lesions occur sporadically or familially throughout the central nervous system.
Purpose:
- To describe the epidemiology, clinical presentation, natural course, and management of cavernomas.
- To evaluate the risks associated with natural progression versus surgical intervention.
- To outline treatment strategies including microsurgical resection and radiosurgery.
Summary:
- Cavernomas affect 0.4-0.5% of the population, presenting with hemorrhage, seizures, or focal deficits, though 20% are asymptomatic.
- The annual risk of bleeding is 0.6%, and epilepsy risk is 1.5%.
- Microsurgical resection is the primary treatment for symptomatic superficial cavernomas with low morbidity; deep-seated lesions require careful risk-benefit assessment.
Impact:
- Informs clinical decision-making for cavernoma management, balancing surgical risks with natural progression.
- Highlights the importance of individualized treatment approaches based on lesion location and patient symptoms.
- Contributes to understanding the natural history and potential complications of cavernomas.
Abstract:
Cavernomas are congenital cerebrovascular hamartomas which occur sporadic or familial. They are comprised of multiple sinusoidal spaces, filled with blood, without enlarged arterial feeders and draining veins. They occur in an estimated 0.4 to 0.5% of the population, with male and female patients equally affected and all ages represented. Lesions are singular or multiple (up to 20%) in the same patient and occur all over the central nervous system. Clinical representation is characterized by cross intracranial hemorrhage, seizures and focal neurological deficits. Unspecific symptoms, like headaches, vertigo and tinnitus were present in 25 to 30% of the patients. Asymptomatic cavernomas could be detected in up to 20% of the cases. The natural course revealed an annual risk of bleeding (0.6%) and a risk of developing epilepsy (1.5%). Microsurgical resection of a symptomatic lesion is the first choice of treatment. There is no mortality and the morbidity after resection of superficial cavernomas is below 5%. Deep seated cavernomas revealed a higher risk of postoperative neurological deficit. Therefore indication of operative removal in deep seated cavernomas should be carefully weighted up to the risk of natural course and generally neurological and radiological control is favoured. Radiosurgery is only indicated in progressively symptomatic cases which are surgical inaccessible.