Treatment strategies and outcome of pediatric cerebral cavernomas

Abstract

We read with great interest the recent article by Consales et al. concerning the treatment and outcome of children with cerebral cavernomas. The authors prospectively studied 32 children with brain cavernomas. A great proportion of cavernomas (65.6%) had macrohemorrhage, whereas 15.6% presented only with seizures. Surgical excision was performed in 28 patients and resulted in favorable long-term outcome and seizure control. The authors concluded that there is a high risk of macrohemorrhage in children with cavernomas and surgery should be performed in most surgically accessible cavernomas [1].We retrospectively studied only the cerebral cavernomas that were treated surgically in our institute over the last 14 years. We identified 16 cases of pediatric cavernomas. The parietal lobe was the most common site of occurrence, whereas only two cavernomas were infratentorial. In our series, there were only 3 children with macrohemorrhage, whereas 14 children presented with seizures. Among them, 8 children had seizures that were controlled by medication, 2 cases were refractory to anticonvulsants and the remaining 4 patients were operated shortly after the first few seizures. In all cases, gross total resection was performed that included the surrounding gliotic and hemosiderin-stained brain parenchyma. After a mean follow-up period of 5.9 years, all patients were in good condition. Concerning the seizure outcome, as assessed by the Engel classification, 11 (78%) patients were seizure-free (class I) and 3 (22%) patients were in class II [2].