An analysis of the natural history of cavernous angiomas

View More View Less
  • 1 Departments of Neurosurgery, Radiology, and Public Health Services, The Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The advent of magnetic resonance (MR) imaging has permitted the recognition of many angiographically occult vascular malformations before the development of complications and subsequent surgical removal. This study reviews all patients at one institution who had radiographically identifiable vascular malformations believed to represent cavernous angiomas in order to obtain information on the natural history of this particular lesion. All 8131 craniospinal MR images performed at our medical center from January 1, 1986, to November 30, 1989, were reviewed, and 32 patients were identified with 76 lesions meeting the MR imaging criteria for cavernous angioma. Medical histories, physical examination records, and other data from these patients were then reviewed to determine the frequency of complications. Their mean age at latest follow-up examination (or at surgical removal of the lesion) was 37.6 years (range 16 to 72 years). Sixteen patients (50%) had a history of seizures, seven (22%) had focal neurological deficits, and three (9%) had clinically significant hemorrhage attributable to the cavernous angioma; six patients (19%) were asymptomatic. The estimated risk of hemorrhage for this population is 0.25%/person-year of exposure; the estimated risk of seizure development is 1.51%/person-year. Eight patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit. Although these lesions are often excised with relative ease and minimal morbidity, the potential risks and benefits of surgery must be weighed carefully before removal of these relatively benign malformations.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: O. Del Curling, Jr., M.D., Department of Neurosurgery, Bowman Gray School of Medicine, 300 South Hawthorne Road, Winston-Salem, North Carolina 27103.
  • 1.

    Ahmadi J, , Miller CA, & Segall HD, et al. : CT patterns in histopathologically complex cavernous hemangiomas. AJNR 6:389393, 1985 Ahmadi J, Miller CA, Segall HD, et al: CT patterns in histopathologically complex cavernous hemangiomas. AJNR 6:389–393, 1985

    • Search Google Scholar
    • Export Citation
  • 2.

    Barnwell SL, , Dowd CF, & Davis RL, et al. : Cryptic vascular malformations of the spinal cord: diagnosis by magnetic resonance imaging and outcome of surgery. J Neurosurg 72:403407, 1990 Barnwell SL, Dowd CF, Davis RL, et al: Cryptic vascular malformations of the spinal cord: diagnosis by magnetic resonance imaging and outcome of surgery. J Neurosurg 72:403–407, 1990

    • Search Google Scholar
    • Export Citation
  • 3.

    Cohen HCM, , Tucker WS, & Humphreys RP, et al. : Angiographically cryptic histologically verified cerebrovascular malformations. Neurosurgery 10:704714, 1982 Cohen HCM, Tucker WS, Humphreys RP, et al: Angiographically cryptic histologically verified cerebrovascular malformations. Neurosurgery 10:704–714, 1982

    • Search Google Scholar
    • Export Citation
  • 4.

    Cosgrove GR, , Bertrand G, & Fontaine S, et al. : Cavernous angiomas of the spinal cord. J Neurosurg 68:3136, 1988 Cosgrove GR, Bertrand G, Fontaine S, et al: Cavernous angiomas of the spinal cord. J Neurosurg 68:31–36, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Crawford PM, , West CR, & Chadwick DW, et al. : Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:110, 1986 Crawford PM, West CR, Chadwick DW, et al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:1–10, 1986

    • Search Google Scholar
    • Export Citation
  • 6.

    Crone KR, , Buckingham M, & Berger TS: Cavernous angiomas in children: clinical presentation, radiological assessment, and surgical treatment. Neurosurgery 21:117118, 1987 (Abstract) Crone KR, Buckingham M, Berger TS: Cavernous angiomas in children: clinical presentation, radiological assessment, and surgical treatment. Neurosurgery 21:117–118, 1987 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 7.

    Ebeling JD, , Tranmer BI, & Davis KA, et al. : Thrombosed arteriovenous malformations: a type of occult vascular malformation. Magnetic resonance imaging and histopathological correlations. Neurosurgery 23:605610, 1988 Ebeling JD, Tranmer BI, Davis KA, et al: Thrombosed arteriovenous malformations: a type of occult vascular malformation. Magnetic resonance imaging and histopathological correlations. Neurosurgery 23:605–610, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Fortuna A, , Ferrante L, & Mastronardi L, et al. : Cerebral cavernous angioma in children. Childs Nerv Syst 5:201207, 1989 Fortuna A, Ferrante L, Mastronardi L, et al: Cerebral cavernous angioma in children. Childs Nerv Syst 5:201–207, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Fults D, & Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658662, 1984 Fults D, Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662, 1984

    • Search Google Scholar
    • Export Citation
  • 10.

    Giombini S, & Morello G: Cavernous angiomas of the brain. Account of fourteen personal cases and review of the literature. Acta Neurochir 40:6182, 1978 Giombini S, Morello G: Cavernous angiomas of the brain. Account of fourteen personal cases and review of the literature. Acta Neurochir 40:61–82, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    Gomori JM, , Grossman RI, & Goldberg HI, et al. : Occult cerebral vascular malformations: high-field MR imaging. Radiology 158:707713, 1986 Gomori JM, Grossman RI, Goldberg HI, et al: Occult cerebral vascular malformations: high-field MR imaging. Radiology 158:707–713, 1986

    • Search Google Scholar
    • Export Citation
  • 12.

    Harris GJ, & Jakobiec FA: Cavernous hemangioma of the orbit. J Neurosurg 51:219228, 1979 Harris GJ, Jakobiec FA: Cavernous hemangioma of the orbit. J Neurosurg 51:219–228, 1979

    • Search Google Scholar
    • Export Citation
  • 13.

    Hayman LA, , Evans RA, & Ferrell RE, et al. : Familial cavernous angiomas. Natural history and genetic study over a 5-year period. Am J Med Genet 11:147160, 1982 Hayman LA, Evans RA, Ferrell RE, et al: Familial cavernous angiomas. Natural history and genetic study over a 5-year period. Am J Med Genet 11:147–160, 1982

    • Search Google Scholar
    • Export Citation
  • 14.

    Isler W: Cerebrovascular diseases in the first three years of life. Brain Dev 2:95105, 1980 Isler W: Cerebrovascular diseases in the first three years of life. Brain Dev 2:95–105, 1980

    • Search Google Scholar
    • Export Citation
  • 15.

    Jain KK, & Robertson E: Recurrence of an excised cavernous hemangioma in the opposite cerebral hemisphere. Case report. J Neurosurg 33:453456, 1970 Jain KK, Robertson E: Recurrence of an excised cavernous hemangioma in the opposite cerebral hemisphere. Case report. J Neurosurg 33:453–456, 1970

    • Search Google Scholar
    • Export Citation
  • 16.

    Krayenbühl H, & Siebenmann R: Small vascular malformations as a cause of primary intracerebral hemorrhage. J Neurosurg 22:720, 1965 Krayenbühl H, Siebenmann R: Small vascular malformations as a cause of primary intracerebral hemorrhage. J Neurosurg 22:7–20, 1965

    • Search Google Scholar
    • Export Citation
  • 17.

    Krayenbühl H, & Yaşargil MG: Die vaskulären Erkrankungen im Gebiet der Arteria vertebralis und Arteria basilaris; eine anatomische und pathologische, Klinische und neuroradiologische studie. Stuttgart: Thieme Verlag, 1957 Krayenbühl H, Yaşargil MG: Die vaskulären Erkrankungen im Gebiet der Arteria vertebralis und Arteria basilaris; eine anatomische und pathologische, Klinische und neuroradiologische studie. Stuttgart: Thieme Verlag, 1957

    • Search Google Scholar
    • Export Citation
  • 18.

    Lobato RD, , Perez C, & Rivas JJ, et al. : Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68:518531, 1988 Lobato RD, Perez C, Rivas JJ, et al: Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68:518–531, 1988

    • Search Google Scholar
    • Export Citation
  • 19.

    Margolis G, , Odom GL, & Woodhall B: Further experiences with small vascular malformations as a cause of massive intracerebral bleeding. J Neuropathol Exp Neurol 20:161167, 1961 Margolis G, Odom GL, Woodhall B: Further experiences with small vascular malformations as a cause of massive intracerebral bleeding. J Neuropathol Exp Neurol 20:161–167, 1961

    • Search Google Scholar
    • Export Citation
  • 20.

    Mason I, , Aase JM, & Orrison WW, et al. : Familial cavernous angiomas of the brain in an Hispanic family. Neurology 38:324326, 1988 Mason I, Aase JM, Orrison WW, et al: Familial cavernous angiomas of the brain in an Hispanic family. Neurology 38:324–326, 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    McCormick WF: The pathology of vascular (“arteriovenous”) malformations. J Neurosurg 24:807816, 1966 McCormick WF: The pathology of vascular (“arteriovenous”) malformations. J Neurosurg 24:807–816, 1966

    • Search Google Scholar
    • Export Citation
  • 22.

    McCormick WF, , Hardman JM, & Boulter TR: Vascular malformations (“angiomas”) of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 28:241251, 1968 McCormick WF, Hardman JM, Boulter TR: Vascular malformations (“angiomas”) of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 28:241–251, 1968

    • Search Google Scholar
    • Export Citation
  • 23.

    McCormick WF, & Nofzinger JD: “Cryptic” vascular malformations of the central nervous system. J Neurosurg 24:865875, 1966 McCormick WF, Nofzinger JD: “Cryptic” vascular malformations of the central nervous system. J Neurosurg 24:865–875, 1966

    • Search Google Scholar
    • Export Citation
  • 24.

    New PF, , Ojemann RG, & Davis KR, et al. : MR and CT of occult vascular malformations of the brain. AJR 147:985993, 1986 New PF, Ojemann RG, Davis KR, et al: MR and CT of occult vascular malformations of the brain. AJR 147:985–993, 1986

    • Search Google Scholar
    • Export Citation
  • 25.

    Pozzati E, , Giuliani G, & Nuzzo G, et al. : The growth of cerebral cavernous angiomas. Neurosurgery 25:9297, 1989 Pozzati E, Giuliani G, Nuzzo G, et al: The growth of cerebral cavernous angiomas. Neurosurgery 25:92–97, 1989

    • Search Google Scholar
    • Export Citation
  • 26.

    Pozzati E, , Padovani R, & Morrone B, et al. : Cerebral cavernous angiomas in children. J Neurosurg 53:826832, 1980 Pozzati E, Padovani R, Morrone B, et al: Cerebral cavernous angiomas in children. J Neurosurg 53:826–832, 1980

    • Search Google Scholar
    • Export Citation
  • 27.

    Rengachary SS, & Kalyan-Raman UP: Other cranial intradural angiomas, in Wilkins RH, & Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, Vol 2, pp 14651472 Rengachary SS, Kalyan-Raman UP: Other cranial intradural angiomas, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, Vol 2, pp 1465–1472

    • Search Google Scholar
    • Export Citation
  • 28.

    Rigamonti D, , Drayer BP, & Johnson PC, et al. : The MRI appearance of cavernous malformations (angiomas). J Neurosurg 67:518524, 1987 Rigamonti D, Drayer BP, Johnson PC, et al: The MRI appearance of cavernous malformations (angiomas). J Neurosurg 67:518–524, 1987

    • Search Google Scholar
    • Export Citation
  • 29.

    Rigamonti D, , Hadley MN, & Drayer BP, et al. : Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343347, 1988 Rigamonti D, Hadley MN, Drayer BP, et al: Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343–347, 1988

    • Search Google Scholar
    • Export Citation
  • 30.

    Runnels JB, , Gifford DB, & Forsberg PL, et al. : Dense calcification in a large cavernous angioma. Case report. J Neurosurg 30:293298, 1969 Runnels JB, Gifford DB, Forsberg PL, et al: Dense calcification in a large cavernous angioma. Case report. J Neurosurg 30:293–298, 1969

    • Search Google Scholar
    • Export Citation
  • 31.

    Russell DS, & Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 5. Baltimore: Williams & Wilkins, 1989, pp 727765 Russell DS, Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 5. Baltimore: Williams & Wilkins, 1989, pp 727–765

    • Search Google Scholar
    • Export Citation
  • 32.

    Savoiardo M, , Strada L, & Passerini A: Intracranial cavernous hemangiomas: neuroradiologic review of 36 operated cases. AJNR 4:945950, 1983 Savoiardo M, Strada L, Passerini A: Intracranial cavernous hemangiomas: neuroradiologic review of 36 operated cases. AJNR 4:945–950, 1983

    • Search Google Scholar
    • Export Citation
  • 33.

    Schneider RC, & Liss L: Cavernous hemangiomas of the cerebral hemispheres. J Neurosurg 15:392399, 1958 Schneider RC, Liss L: Cavernous hemangiomas of the cerebral hemispheres. J Neurosurg 15:392–399, 1958

    • Search Google Scholar
    • Export Citation
  • 34.

    Simard JM, , Garcia-Bengochea F, & Ballinger WE, Jr, et al. : Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18:162172, 1986 Simard JM, Garcia-Bengochea F, Ballinger WE Jr, et al: Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18:162–172, 1986

    • Search Google Scholar
    • Export Citation
  • 35.

    Stieger HJ, , Markwalder TM, & Reulen HJ: Clinicopathological relations of cerebral cavernous angiomas: observations in eleven cases. Neurosurgery 21:879884, 1987 Stieger HJ, Markwalder TM, Reulen HJ: Clinicopathological relations of cerebral cavernous angiomas: observations in eleven cases. Neurosurgery 21:879–884, 1987

    • Search Google Scholar
    • Export Citation
  • 36.

    Steiger HJ, & Tew JM Jr: Hemorrhage and epilepsy in cryptic cerebrovascular malformations. Arch Neurol 41:722724, 1984 Steiger HJ, Tew JM Jr: Hemorrhage and epilepsy in cryptic cerebrovascular malformations. Arch Neurol 41:722–724, 1984

    • Search Google Scholar
    • Export Citation
  • 37.

    Terao H, , Hori T, & Matsutani M, et al. : Detection of cryptic vascular malformations by computerized tomography. Report of two cases. J Neurosurg 51:546551, 1979 Terao H, Hori T, Matsutani M, et al: Detection of cryptic vascular malformations by computerized tomography. Report of two cases. J Neurosurg 51:546–551, 1979

    • Search Google Scholar
    • Export Citation
  • 38.

    Vaquero J, , Salazar J, & Martinez R, et al. : Cavernomas of the central nervous system: clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases. Acta Neurochir 85:2933, 1987 Vaquero J, Salazar J, Martinez R, et al: Cavernomas of the central nervous system: clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases. Acta Neurochir 85:29–33, 1987

    • Search Google Scholar
    • Export Citation
  • 39.

    Voigt K, & Yaşargil MG: Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia 19:5968, 1976 Voigt K, Yaşargil MG: Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia 19:59–68, 1976

    • Search Google Scholar
    • Export Citation
  • 40.

    Wakai S, , Ueda Y, & Inoh S, et al. : Angiographically occult angiomas: a report of thirteen cases with analysis of the cases documented in the literature. Neurosurgery 17:549556, 1985 Wakai S, Ueda Y, Inoh S, et al: Angiographically occult angiomas: a report of thirteen cases with analysis of the cases documented in the literature. Neurosurgery 17:549–556, 1985

    • Search Google Scholar
    • Export Citation
  • 41.

    Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421430, 1985 Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430, 1985

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1213 454 37
Full Text Views 276 23 4
PDF Downloads 137 16 2
EPUB Downloads 0 0 0