Vascular malformations of central nervous system: A series from tertiary care hospital in South India

Abstract

Aims and Objectives:To describe clinicopathological features of surgically resected vascular malformations (VMs) of central nervous system (CNS).Materials and Methods:Histologically diagnosed cases of VMs of CNS during April 2010–April 2014 were included. Demographic data, clinical and radiological features were obtained. Hematoxylin and eosin slides were reviewed along with Verhoeff-Van Gieson (VVG), Masson's trichrome, periodic acid-Schiff, and Perls' stains. Morphologically, cavernomas and arteriovenous malformations (AVMs) were distinguished on the basis of vessel wall features on VVG and intervening glial parenchyma.Results:Fifty cases were diagnosed as VMs of CNS with an age range of 14–62 years. These included 36 cavernomas, 12 AVMs, 2 mixed capillary-cavernous angiomas. Most of the cavernoma patients (15/36) presented with seizures, whereas AVM patients (8/12) had a headache as the dominant symptom. Twenty-nine patients were reliably diagnosed on radiological features. Microscopic evidence of hemorrhage was seen in 24/36 cavernomas and 6/12 AVMs, as opposed to radiologic evidence of 10 and 4, respectively. Reactive gliosis was seen in 16 cavernomas.Conclusions:Histological features are important for classifying the VMs of CNS as there are no specific clinical and radiological features. Type of VM has a bearing on management, prognosis, and risk of hemorrhage.

Pathological Spectrum of Vascular Malformations of the Central Nervous System: A Single Institution Experience of a Decade

“…7 In a study by Karri et al in south India, CCMs were found to be more common than the AVMs, accounting for 72% (36/50) of all VMs. 6…”

“…We found only one other study that documented spectrum of 50 cases of VMs. 6 Most common VMs are AVMs and CCMs, with detection rates of approximately 1.1 and 0.6 per 100,000 adults per year. In our series, CCM were the most common VMs overall, AVMs being the most frequent amongst intracranial VMs and hemangiomas and AVF being most common in spine.…”

The Pattern of Publications on Cerebral Arteriovenous Malformations and Cavernomas in the Middle East and North Africa

“…The main options for the management of AVM include conservative management with serial imaging and observation, microsurgical resection, endovascular embolization, and stereotactic radiosurgery. [5] The combined or staged therapy is also gaining popularity through multidisciplinary decision-making approaches.…”

“…Most of cavernomas were found in cerebral hemispheres (66.7%), spinal cord (13.9%), brain stem (11.1%), and cerebellum (11.1%). [5] AVMs are abnormal complex tangles of blood vessels which cause numerous shunts between the arterial and venous systems. They frequently occur in the brain and to a lesser degree in the spinal cord.…”

Tailored Treatment Options for Cerebral Cavernous Malformations

“…Cerebral cavernous malformations (CCMs) are hamartomas with endothelium-lined vascular chambers [ 1 , 2 ]. CCMs lack developed vascular structures like elastic lamina, smooth muscle, or tight junctions; have no interspersed brain parenchyma; and have a border of nonfunctioning glial tissue [ 1 , 3 ].…”