Surgical management of paediatric cerebral cavernomas

Over the past 15 years (1981-1995) 24 children with cerebral cavernous angiomas have been treated surgically at the Section of Pediatric Neurosurgery of the Catholic University of Rome. The most common symptoms at presentation were epilepsy (13 children) and intracranial hypertension (9 children). None of these patients had a family history of cerebro-vascular malformations. Multiple lesions were detected in two subjects. In 19 cases, radiological signs of significant acute and subacute hemorrhage were present at the radiological examinations. The supratentorial compartment was the most frequent localization of the lesions, with only four cavernomas observed in the subtentorial space. The post-surgical results were good: only nine children had a persistence of the presurgical neurological signs, although ameliorated by the treatment; no patient showed a progression of pre-operative neurological signs, neither the onset of new deficits; only one child died, but his clinical conditions were very critical before surgery. Our results suggest that the youngest children present with evidence of significant hemorrhages more frequently than their older counterpart. In our series, the removal of cavernomas allowed to control the seizure disorders in all the case, thus suggesting that in this type of malformative lesion, lesionectomy alone may be sufficient to resolve epilepsy.