Cerebral cavernous angiomas in critical areas. Reports of three cases in children

Cerebral cavernous angiomas are congenital malformations usually presenting with symptomatic hemorrhages or seizures. The advent of MRI has allowed to detect asymptomatic, "cryptic" brain cavernomas. They can occur in a sporadic, isolated form and in a familial form characterized by multiple lesions. Surgical treatment is recommended by most authors in symptomatic cases when the lesion is isolated and readily accessible. Treatment is more controversial when the vascular malformation is located in critical brain region. On the other hand the increased risk of rebleeding after a prior hemorrhage and the decreased effectiveness of lesionectomy in patients with a long seizure history could lead to perform an early surgical excision also for cavernous angiomas located in those areas. We report three cases of symptomatic cerebral cavernomas located in critical areas, in children. In all cases the surgical removal of the lesions was successfully performed. The two cases presented with seizures are seizure-free in spite of the interruption of the antiepileptic therapy. The patient presented with neurological deficit due to intraparenchymal hemorrhage progressively recovered his motor function. Our experience seems to confirm the value of surgical removal regardless of where the cavernoma is located.