The authors review the pertinent literature dealing with all aspects of cerebral cavernous malformations in the adult. Clinical, neuroradiological, pathological, and epidemiological aspects are presented. The clinical significance of bleeding from cavernous malformations and various hemorrhage patterns are discussed in relation to the factors that influence hemorrhage rates. Recent reports describing the genetic mechanisms of inheritance, de novo formation, and angiogenesis of cavernomas are reviewed as well. Brainstem cavernomas have received special attention, since their clinical management is controversial in the literature. Presently, microsurgical removal is favored by the majority of authors and stereotactic radiosurgery appears to be inappropriate for prevention of bleeding from a cavernoma. Our own case material consists of data of 72 patients operated upon during the past 5 years. Twenty-four patients harbored the lesion within the brainstem, 18 within the deep white matter of the hemispheres, 12 in the basal ganglia or thalamus, 11 in superficial areas of the hemisphere, and seven within the cerebellum. The perioperative morbidity rate was 29.2% (21/72) while the rate of long-term morbidity was 5.5% (4/72), with no mortality in this series. It is concluded that cerebral cavernous malformations, including lesions in critical regions of the brain, can be treated microsurgically with excellent results and an acceptable morbidity.

Background: Since for immune surveillance, only lymphocytes in the activated state are able to enter normal human central nervous system (CNS), available data are briefly reviewed to reveal lymphocyte transfer through bloodbrain barrier (bbb) and blood-cerebrospinal fluid barrier (bCSFb). Methods: With immuno-histochemical and -cytochemical methods, bbb was studied on brain microvessels and bCSFb on choroid plexus epithelium and microvessels. Lymphocyte transfer capacity of the barriers was determined with blood/CSF cell ratios revealed by quantified multicolour flow-cytometry of CSF and blood sample pairs. Results: Four paths attenuated the restricted transfer of lymphocyte and NK cell subsets (none for B cells) through bbb and bCSFb, preferring memory cells in normal human

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The results of this large series support the notion that microsurgical removal of a brainstem cavernoma represents an effective therapy in experienced hands and is generally associated with good clinical outcome, both neurologically and in terms of QoL.

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