An analysis of the natural history of cavernous angiomas

O. Del Curling Jr. M.D. 1 , David L. Kelly Jr. M.D. 1 , Allen D. Elster M.D. 1 and Timothy E. Craven M.S.P.H. 1
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  • 1 Departments of Neurosurgery, Radiology, and Public Health Services, The Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
DOI:
https://doi.org/10.3171/jns.1991.75.5.0702
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✓ 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.

Volume 75: Issue 5 (Nov 1991)

in Journal of Neurosurgery
Cover Volume null: Issue null: Journal of Neurosurgery
Article Information

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.
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References
  • 1.

    Ahmadi JMiller CASegall HDet al: CT patterns in histopathologically complex cavernous hemangiomas. AJNR 6:389–3931985Ahmadi 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 SLDowd CFDavis RLet al: Cryptic vascular malformations of the spinal cord: diagnosis by magnetic resonance imaging and outcome of surgery. J Neurosurg 72:403–4071990Barnwell 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 HCMTucker WSHumphreys RPet al: Angiographically cryptic histologically verified cerebrovascular malformations. Neurosurgery 10:704–7141982Cohen 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 GRBertrand GFontaine Set al: Cavernous angiomas of the spinal cord. J Neurosurg 68:31–361988Cosgrove 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 PMWest CRChadwick DWet al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:1–101986Crawford 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 KRBuckingham MBerger TS: Cavernous angiomas in children: clinical presentation, radiological assessment, and surgical treatment. Neurosurgery 21:117–1181987 (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 JDTranmer BIDavis KAet al: Thrombosed arteriovenous malformations: a type of occult vascular malformation. Magnetic resonance imaging and histopathological correlations. Neurosurgery 23:605–6101988Ebeling 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 AFerrante LMastronardi Let al: Cerebral cavernous angioma in children. Childs Nerv Syst 5:201–2071989Fortuna 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 DKelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–6621984Fults 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 SMorello G: Cavernous angiomas of the brain. Account of fourteen personal cases and review of the literature. Acta Neurochir 40:61–821978Giombini 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 JMGrossman RIGoldberg HIet al: Occult cerebral vascular malformations: high-field MR imaging. Radiology 158:707–7131986Gomori 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 GJJakobiec FA: Cavernous hemangioma of the orbit. J Neurosurg 51:219–2281979Harris GJ Jakobiec FA: Cavernous hemangioma of the orbit. J Neurosurg 51:219–228 1979

    • Search Google Scholar
    • Export Citation
  • 13.

    Hayman LAEvans RAFerrell REet al: Familial cavernous angiomas. Natural history and genetic study over a 5-year period. Am J Med Genet 11:147–1601982Hayman 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 2:95–1051980Isler W: Cerebrovascular diseases in the first three years of life. Brain Dev 2:95–105 1980

    • Search Google Scholar
    • Export Citation
  • 15.

    Jain KKRobertson E: Recurrence of an excised cavernous hemangioma in the opposite cerebral hemisphere. Case report. J Neurosurg 33:453–4561970Jain 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 HSiebenmann R: Small vascular malformations as a cause of primary intracerebral hemorrhage. J Neurosurg 22:7–201965Krayenbühl 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 HYaşargil MG: Die vaskulären Erkrankungen im Gebiet der Arteria vertebralis und Arteria basilaris; eine anatomische und pathologische Klinische und neuroradiologische studie. Stuttgart: Thieme Verlag1957Krayenbühl 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 RDPerez CRivas JJet al: Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68:518–5311988Lobato 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 GOdom GLWoodhall B: Further experiences with small vascular malformations as a cause of massive intracerebral bleeding. J Neuropathol Exp Neurol 20:161–1671961Margolis 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 IAase JMOrrison WWet al: Familial cavernous angiomas of the brain in an Hispanic family. Neurology 38:324–3261988Mason 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 24:807–8161966McCormick WF: The pathology of vascular (“arteriovenous”) malformations. J Neurosurg 24:807–816 1966

    • Search Google Scholar
    • Export Citation
  • 22.

    McCormick WFHardman JMBoulter TR: Vascular malformations (“angiomas”) of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 28:241–2511968McCormick 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 WFNofzinger JD: “Cryptic” vascular malformations of the central nervous system. J Neurosurg 24:865–8751966McCormick WF Nofzinger JD: “Cryptic” vascular malformations of the central nervous system. J Neurosurg 24:865–875 1966

    • Search Google Scholar
    • Export Citation
  • 24.

    New PFOjemann RGDavis KRet al: MR and CT of occult vascular malformations of the brain. AJR 147:985–9931986New 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 EGiuliani GNuzzo Get al: The growth of cerebral cavernous angiomas. Neurosurgery 25:92–971989Pozzati 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 EPadovani RMorrone Bet al: Cerebral cavernous angiomas in children. J Neurosurg 53:826–8321980Pozzati 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 SSKalyan-Raman UP: Other cranial intradural angiomas in Wilkins RHRengachary SS (eds): Neurosurgery. New York: McGraw-Hill1985 Vol 2 pp 1465–1472Rengachary 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 DDrayer BPJohnson PCet al: The MRI appearance of cavernous malformations (angiomas). J Neurosurg 67:518–5241987Rigamonti 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 DHadley MNDrayer BPet al: Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343–3471988Rigamonti 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 JBGifford DBForsberg PLet al: Dense calcification in a large cavernous angioma. Case report. J Neurosurg 30:293–2981969Runnels 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 DSRubinstein LJ: Pathology of Tumours of the Nervous Systemed 5. Baltimore: Williams & Wilkins1989 pp 727–765Russell 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 MStrada LPasserini A: Intracranial cavernous hemangiomas: neuroradiologic review of 36 operated cases. AJNR 4:945–9501983Savoiardo 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 RCLiss L: Cavernous hemangiomas of the cerebral hemispheres. J Neurosurg 15:392–3991958Schneider RC Liss L: Cavernous hemangiomas of the cerebral hemispheres. J Neurosurg 15:392–399 1958

    • Search Google Scholar
    • Export Citation
  • 34.

    Simard JMGarcia-Bengochea FBallinger WEJret al: Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18:162–1721986Simard 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 HJMarkwalder TMReulen HJ: Clinicopathological relations of cerebral cavernous angiomas: observations in eleven cases. Neurosurgery 21:879–8841987Stieger 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 HJTew JM Jr: Hemorrhage and epilepsy in cryptic cerebrovascular malformations. Arch Neurol 41:722–7241984Steiger HJ Tew JM Jr: Hemorrhage and epilepsy in cryptic cerebrovascular malformations. Arch Neurol 41:722–724 1984

    • Search Google Scholar
    • Export Citation
  • 37.

    Terao HHori TMatsutani Met al: Detection of cryptic vascular malformations by computerized tomography. Report of two cases. J Neurosurg 51:546–5511979Terao 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 JSalazar JMartinez Ret al: Cavernomas of the central nervous system: clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases. Acta Neurochir 85:29–331987Vaquero 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 KYaşargil 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 19:59–681976Voigt 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 SUeda YInoh Set al: Angiographically occult angiomas: a report of thirteen cases with analysis of the cases documented in the literature. Neurosurgery 17:549–5561985Wakai 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 16:421–4301985Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430 1985

    • Search Google Scholar
    • Export Citation
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