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Francesco Certo, Giada Toccaceli, Roberto Altieri, and Giuseppe M. V. Barbagallo

Transcript We present a case of thalamomesencephalic cavernoma removed by anterior transcallosal transchoroidal approach. The patient is a 62-year-old man who presented, after mild brain injury, acute onset of diplopia, headache, and vomiting. Because of persistence of symptoms, he performed a brain CT that showed a right thalamomesencephalic bleeding, with a maximum diameter of 12 mm. For these reasons, patient was admitted in Neurosurgery Department and performed an MRI scan that showed a right periaqueductal gray mesencephalic and thalamic cavernoma and the

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Harel Deutsch, George I. Jallo, Alina Faktorovich, and Fred Epstein

C avernomas are well-circumscribed lesions that consist of closely packed, capillary-like vessels, without intervening brain or spinal tissue. The term cavernoma is synonymous with cavernous malformation, cavernous angioma, and cavernous hemangioma. These lesions are angiographically occult vascular malformations. They have no large vascular supply or significant venous drainage. On gross inspection they have a “mulberry” appearance and are hemosiderin stained. 24 Microscopically, they are characterized by thin-walled sinusoidal vascular channels. Cavernomas

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Jamie J. Van Gompel, Jesus Rubio, Gregory D. Cascino, Gregory A. Worrell, and Fredric B. Meyer

C erebral cavernous hemangiomas, or cavernomas, are benign, low-flow, arteriolar vascular malformations consisting of thin, loosely organized, and collagenous vascular channels with no intervening neural parenchyma. It is believed that the majority of cavernomas are clinically cryptogenic, as they constitute 16% of vascular malformations at autopsy. 1 One of the common clinical manifestations is seizures or epilepsy, occurring in 40–70% of patients presenting with these lesions. 2 , 15 One of the issues regarding the surgical treatment of cavernoma

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Juri Kivelev, Mika Niemelä, and Juha Hernesniemi

S pinal cavernomas are a rare pathology. While the incidence of spinal cavernomas is unknown, they represent 5% to 12% of spinal vascular abnormalities. 16 In addition, the natural history of spinal cavernomas remains undefined. Progressive myelopathy caused by typical microhemorrhages and perifocal gliosis probably explains the neurological decline of affected patients. 19 Risk of profuse hemorrhage ranges between 1.4% and 4.5% per patient per year, increasing to 66% per patient per year in patients with a previous history of hemorrhage. 61 , 81 Due to

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Neurosurgical Forum: Letters to the Editor To the Editor Richard E. Clatterbuck , M.D. John L. Moriarity , M.D. Daniele Rigamonti , M.D. Baltimore, Maryland 156 157 Object. Improved neuroimaging techniques have led to an increase in the reported cases of intramedullary cavernomas. The purpose of this study was to define the spectrum of presenting signs and symptoms in patients with spinal intramedullary cavernomas and to analyze the role of surgery as a treatment for these

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Eva Pamias-Portalatin, Ivan Segura Duran, James Ebot, Elird Bojaxhi, William Tatum, and Alfredo Quiñones-Hinojosa

Cavernomas make up approximately 8%–15% of all intracranial vascular malformations, and the most common presenting symptom is seizures. Complete resection of the cavernoma and removal of the surrounding gliotic core presents a cure but poses a challenge if an eloquent brain is involved or with incomplete resection of the epileptogenic foci. The authors present the case of a 53-year-old man with intractable seizures from a left posterior temporal lobe cavernoma who underwent an awake craniotomy with intraoperative seizure monitoring via electrocorticography.

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Kenji Ohata, Alaa El-Naggar, Toshihiro Takami, Michiharu Morino, Yousry El-Adawy, Kanan El-Sheik, Yuichi Inoue, and Akira Hakuba

E xtraaxial cavernomas are rare vascular lesions comprising 0.4 to 2% of all intracranial vascular malformations 51 and most commonly occurring during the patient's fourth decade of life; women are predominantly affected. 1–7, 10–35, 37–50 Although extraaxial cavernomas share identical histopathological features with intraaxial lesions, they are a distinct clinical entity with respect to presentation, radiological features, and management. 51 The middle fossa is the site most commonly affected by these lesions, which arise from within the cavernous sinus

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Sean M. Lew, Joseph N. Morgan, Estee Psaty, Daniel R. Lefton, Jeffrey C. Allen, and Rick Abbott

I n 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous intracerebral hemorrhages developed in sites other than the primary tumor site, several years after undergoing craniospinal radiation therapy. All three hemorrhages required surgical evacuation. Histological examination revealed microscopic anomalous blood vessels in two of the three surgical specimens. In 1994, Ciricillo, et al., 8 reported seven cases of intracerebral cavernomas in pediatric patients whose tumors had been previously irradiated for

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Juri Kivelev, Elina Koskela, Kirsi Setälä, Mika Niemelä, and Juha Hernesniemi

C avernomas are usually detected between the 2nd and 5th decades of life. 6 , 15 , 21 , 26 The most frequent manifestations of the disease are seizures, focal neurological deficits, and hemorrhage. 1 , 2 , 18 , 23 The risk of symptomatic bleeding depends on the location of the cavernoma, generally increasing in deeper lesions of the brain; these risks amount to 0.1%–5% per patient-year (rebleeding risk 5%–60% per patient-year). 7 , 10 , 11 , 16 , 19 , 21 , 24 , 26 Cavernomas located in the occipital region are relatively rare. Microsurgical removal of

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Carlos Candanedo, Samuel Moscovici, and Sergey Spektor

Transcript 0:20 Introduction This is Dr. Carlos Candanedo from Hadassah Hebrew University Medical Center in Jerusalem. I’ll be demonstrating a complex medulla oblongata cavernous malformation resection through a modified far lateral approach. 0:35 Patient clinical history The patient is a 63-year old female who was diagnosed with a large cavernoma located in the medulla oblongata. After suffering three episodes of brainstem bleeding treated conservatively in another institution, she was referred for surgical evaluation. 0:53 Physical examination On physical