Neurosurgical management of cerebellar cavernous malformations

Oliveira, Jean Gonçalves de; Rassi-Neto, Aziz; Ferraz, Fernando Antônio Patriani; Braga, Fernando Menezes

doi:10.3171/foc.2006.21.1.12

Cited by 31 publications

(18 citation statements)

References 50 publications

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“…Infratentorial CMs make up from 9 to 35% of all intracranial CMs [63,64,65], and they can represent more than 20% of intracranial lesions in children [10, 66], with a reported predominance in females [10, 29, 66, 67]. In our pediatric patients, posterior fossa CMs accounted for 7.5% of the intracranial lesions; 40% were located in the brainstem and 60% in the cerebellum.…”

Section: Resultsmentioning

confidence: 99%

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

et al. 2009

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Objective: The main clinico-diagnostic features, risk factors and associated diseases of cavernous malformations (CMs), also called cavernous angiomas or cavernomas, of the central nervous system (CNS) in children are described, and the most relevant differences compared to the affected adult population are pointed out, focusing on the management of pediatric patients harboring cranial and spinal CMs. Materials: This was a retrospective study of a series of 42 children symptomatic for CMs of the cranial and spinal compartments (35 supratentorial brain lesions, 5 infratentorial and 2 in the spinal region) operated on between 1975 and 2005, with a clinical follow-up ranging from 12 to 192 months. The results were compared with those found in the most recent literature dealing with pediatric CMs of the CNS. Results: Surgical treatment produced excellent or good results in 69% of our 42 children. Unchanged neurological deficits were observed in 23.8% of cases, while morbidity from surgical procedures was 7.14%. Mortality was absent in this series. These surgical results are comparable with those found in the literature, where morbidity and mortality rates from surgery are 8.8 and 1.13%, respectively, and are mostly associated with procedures for the excision of deep, critically located cavernomas. Conclusion: CMs represent the most common CNS vascular lesion in children, although their incidence is 4 times lower than that of the adult population. The natural history of pediatric CMs throughout the neuraxis seems to be more aggressive than in adult patients; these lesions have higher rates of growth and hemorrhage, larger dimensions and often atypical radiological pictures at diagnosis. Beside the familial form of the disease, which is more often associated with multiple lesions and an earlier age of clinical presentation, the major risk factor for CMs in children seems to be radiotherapy for CNS tumors. Furthermore, a greater number of CMs coexistent with mixed angiomatous lesions have been reported in children than in adults. Surgical results are related to the preoperative neurological status of the children; symptomatic patients who are operated on early, before they develop severe neurological deficits or long-standing seizures, may achieve the best clinical outcome. Radiosurgery does not seem to be advisable in children as an alternative treatment for deep CMs or those causing epilepsy.

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Section: Resultsmentioning

confidence: 99%

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

et al. 2009

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“…These malformations are usually located in the white matter but may reach the cortex and are surrounded by hemosiderin deposits and gliosis that may or may not be thrombosed. Cavernous malformations represent approximately 5 to 20% of all central nervous system vascular malformations, and their incidence in the general population ranges from 0.4 to 0.9% (de Oliveira et al 2006). The most common symptom of cavernous malformation is a seizure disorder, possibly caused by the toxic effects of the iron deposition associated with subclinical or clinically evident hemorrhage (Farmer et al 1988).…”

Section: Vascular Malformationsmentioning

confidence: 98%

“…Cerebellar cavernous malformations are rare, but can reach large sizes and cause massive hemorrhages, resulting in acute presentation. Clinical presentation of these lesions may include ataxia, dysmetria, nystagmus, and cerebellar speech (de Oliveira et al 2006).…”

Section: Vascular Malformationsmentioning

confidence: 99%

Neuropsychological Features of Lesion-related Epilepsy in Adults: An Overview

Morrison

Nakhutina

2007

Neuropsychol Rev

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Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.

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“…18,20,26 Surgical removal of symptomatic CCM is considered the treatment of choice with a good overall outcome. 2,5,[9][10][11]16,19,24 All patients in our series also underwent excision of the CCM and associated hematomas with an excellent overall clinical outcome. Considering their location, CCMs are straightforward to access surgically.…”

Section: Treatment Options and Outcomementioning

confidence: 99%

Cerebellar cavernous malformation in pediatric patients: defining clinical, neuroimaging, and therapeutic characteristics

Knerlich-Lukoschus

Steinbok

Dunham

et al. 2015

PED

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OBJECT Cerebellar cavernous malformations (CCMs) have not been specifically described in the pediatric age group. Authors of this study, after considering the published literature, describe the characteristic clinical, radiological, and surgical features of CCM in children. METHOSDS Patients younger than 18 years of age who were known to have CCM and had undergone surgery between 1992 and 2014 at the authors’ institution were reviewed. Pediatric CCM cases reported in the literature (case reports and cases included in series on CMs in the pediatric age group) were also analyzed for specific features of this entity. RESULTS Four male patients and 1 female patient (2.5–14 years of age) with CCM presented acutely with severe headache followed by cerebellar dysfunction. In all patients, neuroimaging (cranial CT and MRI) demonstrated hemorrhagic cerebellar lesions with heterogeneous T1 and T2 signal intensities and hyperintense blooming on susceptibility-weighted imaging. The lesions reached large sizes exhibiting spherical, cystic, and often “pseudotumoral” morphology. In 3 patients, developmental venous anomalies (DVAs) were found. In 4 of the 5 patients, the CCMs and hematomas were totally removed. All patients had a clinically excellent functional outcome without surgical complication and with complete resolution of their presenting symptoms. CONCLUSIONS Cerebellar CMs occur in all pediatric age groups and display characteristic clinical and imaging features. In children, CCMs reach large sizes and can result in massive hemorrhage, often leading to a possible diagnosis of hemorrhage into a tumor. An associated DVA is quite common. Surgery is a safe and efficient treatment option with excellent outcomes in patients.

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Neurosurgical management of cerebellar cavernous malformations

Cited by 31 publications

References 50 publications

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

Neuropsychological Features of Lesion-related Epilepsy in Adults: An Overview

Cerebellar cavernous malformation in pediatric patients: defining clinical, neuroimaging, and therapeutic characteristics

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