Cerebral cavernous hemangiomas in childhood. Clinical presentation and therapeutic considerations

Cerebral cavernous hemangiomas (CCH) are relatively rare vascular hamartomas. Since the introduction of MRI there has been an increase in the number of case reports of CCH in the medical literature. CCH are often asymptomatic; they may, however, cause epilepsy or neurological deficits due to their space-occupying effects or hemorrhagic sequelae. The tendency of CCH to bleed has been well recognized, though gross hemorrhage is infrequent owing to the relatively low blood pressure and small blood flow in CCH. MRI findings of a CCH are characteristic and can differentiate the lesions from other vascular abnormalities. To date, there has been no consensus on indications for surgical intervention. Three cases are presented, which together demonstrate by their different presentation, clinical course and MRI findings that each patient with a CCH requires an individually tailored management. Presentation, clinical course and accessibility for operation are the factors that determine whether a surgical or a conservative approach should be adopted.