Surgical management of cavernous angiomas in children

Giulioni, Marco; Acciarri, Nicola; Padovani, Roberto; Frank, F.; Galassi, Ercole; Gaist, G

doi:10.1016/0090-3019(94)90262-3

Cited by 28 publications

(24 citation statements)

References 28 publications

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“…Exception is made for multiple asymptomatic cerebellar CMs 4 . Cerebellar cavernomas represent 0.0 to 13.8% in earlier studies 3,6,[8][9][10][17][18][19] , in our series there were two patients in this group (6.6%).…”

Section: Cerebellar Cavernomas (G2)mentioning

confidence: 61%

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Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

Amato¹,

Madureira²,

Oliveira³

2013

Arq. Neuro-Psiquiatr.

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Objectives: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. Methods: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. Results: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. Conclusions: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.

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Section: Cerebellar Cavernomas (G2)mentioning

confidence: 61%

“…Brainstem CMs constitute 0 to 21% of all cavernomas in different pediatric series 3,6,[8][9][10][17][18][19] . Clinical presentation is generally acute and severe due to peculiar localization, despite frequent small amount of hemorrhage.…”

Section: Brain Steam Cavernomas (G1)mentioning

confidence: 99%

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

Amato¹,

Madureira²,

Oliveira³

2013

Arq. Neuro-Psiquiatr.

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“…Similarly to adults with CMs, no relevant sex differences have been documented in children [8, 10, 12, 13, 20], although some authors have reported a female predominance in very young patients and a male predominance in spinal cases [21,22,23]. As in the majority of pediatric series, we conventionally considered patients ranging from 0 to 18 years of age, although some authors believe it is more correct to consider as children only those patients up to 15–16 years of age [24].…”

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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“…13,20,24,27,40 In our experience, CCM accounted for 18% of CMs. In our surgical series, the occurrence was 21.7% of cranial CMs.…”

Section: Discussion Incidence and Sex Distribution Of Ccm In Childrenmentioning

confidence: 99%

“…3,22,33 Cavernous malformations in the pediatric age group were reported to be more prone to bleeding with a more dramatic clinical course than those in adults. 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.…”

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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Surgical management of cavernous angiomas in children

Cited by 28 publications

References 28 publications

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

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

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

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