1,420 results on '"cavernous malformation"'
Search Results
202. Surgical Approach to Ponto-mesencephalic Cavernoma
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Kaku, Yasuhiko, Takei, Hiroaki, Miyai, Masafumi, Yamashita, Kentarou, Kokuzawa, Jouji, Steiger, H.-J., Series editor, Tsukahara, Tetsuya, editor, Pasqualin, Alberto, editor, Esposito, Giuseppe, editor, Regli, Luca, editor, and Pinna, Giampietro, editor more...
- Published
- 2016
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203. Brain Vascular Malformations
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Jacinto, João Maia, Fragata, Isabel Ribeiro, Hoffmann Nunes, Renato, editor, Abello, Ana Lorena, editor, and Castillo, Mauricio, editor
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- 2016
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204. Cavernous Malformations of the Central Nervous System: An International Consensus Statement
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Tasiou, Anastasia, Brotis, Alexandros G., Kalogeras, Adamantios, Tzerefos, Christos, Alleyne, Cargill H., Andreou, Alexandros, Demetriades, Andreas K., Foroglou, Nikolaos, Friedlander, Robert M., Karlsson, Bengt, Kitchen, Neil, Meling, Torstein R., Mitsos, Aristotelis, Panagiotopoulos, Vasilios, Papasilekas, Themistoklis, Pavesi, Giacomo, Rasulic, Lukas, Santos, Alejandro N., Spetxler, Robert F., Sure, Ulrich, Tjoumakaris, Stavropoula, Tolias, Christos M., Vajkoczy, Peter, Fountas, Kostas N., Tasiou, Anastasia, Brotis, Alexandros G., Kalogeras, Adamantios, Tzerefos, Christos, Alleyne, Cargill H., Andreou, Alexandros, Demetriades, Andreas K., Foroglou, Nikolaos, Friedlander, Robert M., Karlsson, Bengt, Kitchen, Neil, Meling, Torstein R., Mitsos, Aristotelis, Panagiotopoulos, Vasilios, Papasilekas, Themistoklis, Pavesi, Giacomo, Rasulic, Lukas, Santos, Alejandro N., Spetxler, Robert F., Sure, Ulrich, Tjoumakaris, Stavropoula, Tolias, Christos M., Vajkoczy, Peter, and Fountas, Kostas N. more...
- Abstract
Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial. Research question: A consensus may navigate neurosurgeons through the decision-making process of selecting the optimal treatment for asymptomatic and symptomatic CMs. Material and methods: A 17-item questionnaire was developed to address controversial issues in relation to aspects of the treatment, surgical planning, optimal surgical strategy for specific age groups, the role of stereotactic radiosurgery, as well as a follow-up pattern. Consequently, a three-stage Delphi process was ran through 19 invited experts with the goal of reaching a consensus. The agreement rate for reaching a consensus was set at 70%. Results: A consensus for surgical intervention was reached on the importance of the patient’s age, symptomatology, and hemorrhagic recurrence; and the CM’s location and size. The employment of advanced MRI techniques is considered of value for surgical planning. Observation for asymptomatic eloquent or deep-seated CMs represents the commonest practice among our panel. Surgical resection is considered when a deep-seated CM becomes symptomatic or after a second bleeding episode. Asymptomatic, image-proven hemorrhages constituted no indication for surgical resection for our panelists. Consensus was also reached on not resecting any developmental venous anomalies, and on resecting the associated hemosiderin rim only in epilepsy cases. Discussion and conclusion: Our Delphi consensus provides an expert common practice for specific controversial issues of CM patient management. more...
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- 2023
205. A rare case of cavernous malformation of the cauda equina a case report.
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Calderon, Chrystal, Baron, Jodi, Ramdass, Ariane, Ramcharan, Robert, and Ramnarine, Devindra
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Cavernous malformation of the cauda equina is a rare neurosurgical condition. We sought to highlight one of these cases and its resultant diagnosis and management. Additionally, to recommend the need for raised clinical suspicion of these rare masses when an extramedullary lesion is noted on imaging. A 42-year-old female presented to our institution with a 9-month history of lower back pain. Her examination findings revealed a loss of right ankle jerk reflex. Magnetic resonance imaging (MRI) of her lumbosacral spine demonstrated an intradural, extramedullary tumor involving the cauda equina, at the L4/L5 level. The main differential diagnosis at this time was an ependymoma. An L4/5 laminectomy and resection of the cauda equina mass was scheduled. Intra-operatively, a mulberry – like mass was noted involving a single nerve root. A gross total resection was performed, with resolution of most of her symptoms. Histopathological diagnosis of a cavernous malformation was ascertained. The accurate diagnosis of a cavernous malformation of the cauda equina was only suspected intra-operatively, following gross inspection. Cauda equina masses usually include myxopapillary ependymomas and schwannomas, making this vascular extramedullary lesion low on the possible differentials list. Very few cases have been published in modern literature. Cavernous malformations of the cauda equina are an extremely uncommon, benign vascular malformation. These malformations have key characteristics on MRI that can aid its differentiation from other intradural lesions. However, because it is so rare, it does not usually make the list of differentials when considering likely extramedullary lesions. • Cauda equina cavernous malformation is a rare neurosurgical diagnosis. • Specific MRI sequences are most useful in diagnosis of cavernous malformations. • Surgical intervention is recommended for symptomatic patients. • Total resection of cavernous malformation helps prevent recurrence and hemorrhage. [ABSTRACT FROM AUTHOR] more...
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- 2024
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206. Spinal epidural cavernous hemangiomas in the lumbar spine: A case report.
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Zhao, Dingyan, Ma, Yukun, Yu, Xing, Bi, Lianyong, and Yue, Xinliang
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Spinal epidural cavernous hemangiomas (SECHs) are relatively rare intradural epidural lesions of the spinal canal, and those occurring in the lumbar spine are even rarer. A 60-year-old man presented for low back pain with right leg pain. His pee and feces were both normal but symptoms were very similar to a typical lumbar disc herniation. The MRI findings suggest an epidural space of unknown nature in the spinal cord at the L2–3 level and a definite diagnosis of SECHs was made by postoperative pathological examination. Patients who are suspected of having SECHs should undergo initial classification and differential diagnosis based on MRI imaging features. It is crucial to identify the responsible segment in correlation with the presenting symptoms. During surgery, the primary objective should be the complete removal of the mass, while taking utmost care to protect the nerves. Dynamic stabilization systems, utilizing pedicle rods, can be considered as one of the treatment options for such patients. Patients presenting with low back pain and neurological symptoms should undergo MRI, and diagnosed with SECHs should undergo early surgical intervention. For patients with an intradural mass in the spinal canal, complete resection should be performed while prioritizing nerve protection. • The manifestation of spinal epidural cavernous hemangiomas (SECHs) in patients can closely mirror that of standard lumbar disc herniation, thereby emphasizing the importance of MRI scanning. • Performing a preliminary differential diagnosis of potential SECHs patients based on MRI results holds significant importance. • Upon identifying the responsible segment in SECHs patients, surgical action should be swiftly yet carefully undertaken, with a key emphasis placed on the vigilant protection of nerve tissue throughout the procedure. [ABSTRACT FROM AUTHOR] more...
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- 2024
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207. Neurosurgery for Intracranial and Spinal Cavernomas
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Belkhair, Sirajeddin, Maldonado, Amancio Guerrero, Tymianski, Michael, Radovanovic, Ivan, and Lanzer, Peter, editor
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- 2015
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208. Vascular Diseases: Cerebral Hemorrhage
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Caputi, Luigi, Bersano, Anna, Parati, Eugenio Agostino, Sghirlanzoni, Angelo, editor, Lauria, Giuseppe, editor, and Chiapparini, Luisa, editor
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- 2015
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209. Warfarin (Coumadin)
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Hashim, Jeffrey, Ginat, Daniel Thomas, Small, Juan E., Ginat, Daniel Thomas, editor, Small, Juan E., editor, and Schaefer, Pamela Whitney, editor
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- 2015
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210. Radiosurgery for Cavernous Malformations and Other Vascular Diseases
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Niranjan, Ajay, Bowden, Greg, Flickinger, John C., Lunsford, L. Dade, Chin, Lawrence S., editor, and Regine, William F., editor
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- 2015
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211. Cerebral Cavernous Malformations: Viewpoint—Surgery
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Dodd, Robert L., Steinberg, Gary K., Chin, Lawrence S., editor, and Regine, William F., editor
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- 2015
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212. Microscopic trans-cerebellar approach for infratentorial cavernous malformation near the lateral recess associated with developmental venous anomaly
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Samer S. Hoz, Awfa A. Aktham, Hassan M. Bdaiwi, Alyaa A. Khadim, Zainab A. Jihan, and Mohammed Maan AbdulAzeez
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cavernous malformation ,developmental venous anomaly ,trans-cerebellar approach ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Reports showed the intimate association of the developmental venous anomaly with infra-tentorial cavernous malformation. This association has several clinical and surgical implications, sometimes this association will be a surgical challenge and affect the selection of the safest approach to the lesion. Surgery for infratentorial cavernoma is indicated for accessible symptomatic lesion only. Case scenario: we present a case of deep cerebello-pontine CM adjacent to the lateral recess, presented with acute clinical deterioration to the emergency department of the Neurosurgery Teaching Hospital in Baghdad, Iraq, with the only possible approach was Trans-cerebellar approach because of the medial location of the associated DVA. Conclusion: The association of developmental venous anomaly with infratentorial cavernous malformation has a pivotal role in selection the most appropriate and safe surgical approach which should be based upon the individualized patient anatomy and the location of the target lesion. more...
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- 2019
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213. Temporal Lobe Cavernous Malformation Caused Epileptic Amnesic Episodes and Mild Cognitive Impairment
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Yusuke Hirokawa, Ayataka Fujimoto, Naoki Ichikawa, Keishiro Sato, Tokutaro Tanaka, Hideo Enoki, Yoshiro Otsuki, and Tohru Okanishi
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cavernous malformation ,epileptic amnesia ,subdural electrode recording ,Alzheimer disease-like symptoms ,amyloid β ,hyperexcitability of the medial temporal lobe ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Neuropathological features in Alzheimer's disease (AD) are amyloid β (Aβ) deposits and neurofibrillary changes. AD is characterized by memory impairment and cognitive dysfunction, with some reports associating these impairments with hyperexcitability caused by Aβ in the medial temporal lobe. Epileptic seizures are known to be common in AD. We encountered a 65-year-old patient with cavernous malformation (CM) in the right temporal lobe who exhibited epileptic amnesia (EA) and AD-like symptoms. Scalp electroencephalography (EEG), including long-term video-EEG, showed no interictal discharges, but intraoperative subdural electrode (SE) recording from the right parahippocampal area showed frequent epileptiform discharges. Neuropathologically, senile plaques were found in the surrounding normal cortex of the CM. Postoperatively, the patient has remained free of EA and AD-like symptoms since total removal of the CM. This is the first surgical case report to confirm temporal lobe hyperexcitability associated with EA and AD-like symptoms. more...
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- 2019
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214. Adhesive arachnoiditis, subarachnoid hemorrhage, and intradural extramedullary thoracic cavernoma: illustrative case.
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Andriuskeviciute A, Mondragón-Soto MG, Penet N, and Barges-Coll J
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Background: Spinal arachnoiditis can result from various factors, including spinal subarachnoid hemorrhage (sSAH). In this paper, the authors describe a case of intradural extramedullary cavernoma with an initial presentation of subarachnoid hemorrhage leading to multilevel spinal arachnoiditis to discuss the pathophysiology and optimal treatment strategy., Observations: Spinal intradural extramedullary cavernoma manifesting with sSAH is a rare clinical presentation; therefore, there is no clear strategy for the management of sSAH. Spinal arachnoiditis is a result of chronic inflammation of the pia arachnoid layer due to hematomyelia. No effective treatment that interrupts this inflammatory cascade and would also prevent the development of spinal arachnoiditis has been described to date., Lessons: Lumbar drainage could aid in sSAH management, relieve spinal cord compression, and restore the normal spinal cerebrospinal fluid circulation gradient. It could help to clear the blood degradation products rapidly and prevent early inflammatory arachnoiditis development. Mini-invasive intrathecal endoscopic adhesiolysis appears to be a reasonable approach for reducing the risk of aggravating spinal arachnoiditis with a mechanical-surgical stimulus. Whether a conservative approach should be applied in these patients with mild myelopathy symptoms is still debatable. more...
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- 2024
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215. Cavernous malformation located medially and deeply in the brain may be prone to false lateralization in cavernous malformation-associated epilepsy.
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Hatano K, Sato K, Nakamura T, Hotta R, Numoto S, and Fujimoto A
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Background: Cavernous malformation (CM) is a well-known cause of epilepsy. Although the location of the CM is usually consistent with the side of seizure onset, some reports have described discrepancies between results from scalp electroencephalography (EEG) and CM location. This study investigated the prevalence and features of patients showing false lateralization (FL). Particularly, we tested the hypothesis that patients showing FL were more likely to have CM in medial and deep areas of the brain than in other areas., Methods: Patients diagnosed with CM-associated epilepsy in our institution between March 2009 and March 2023 were included in this retrospective analysis. We investigated the presence or absence of FL of interictal epileptiform discharges (IEDs) or ictal discharges against MRI findings or against the true focus as determined from surgical outcomes. We compared the FL group with the non-false-lateralization group (NFL group) to clarify features of CM-associated epilepsy patients showing FL., Results: Thirty-two epilepsy patients with CM were analyzed. The frequency of FL to MRI was 10.3% for IEDs and 7.7% for ictal discharges, while the frequency of FL to true focus after removal surgery was 10.5% for IEDs and 7.7% for ictal discharges. Regarding the FL of IEDs against MRI findings, the percentage of medial and deep lesions was significantly higher in the FL group (3/3, 100%) than in the NFL group (6/26, 23.1%; p = 0.023). No significant differences in age, sex, seizure type, or size of the CM were seen between groups., Conclusions: CM-associated epilepsy can also present with FL, particularly if the location of the CM is medial and deep. Caution may be needed in determining the area for resection based solely on scalp EEG findings., Competing Interests: The authors declare no conflict of interest.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).) more...
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- 2024
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216. Eloquent noneloquence: redefinition of cortical eloquence based on outcomes of superficial cerebral cavernous malformation resection.
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Hendricks BK, Scherschinski L, Jubran JH, Dadario NB, Karahalios K, Benner D, VanBrabant D, and Lawton MT
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- Humans, Female, Male, Adult, Middle Aged, Retrospective Studies, Treatment Outcome, Neurosurgical Procedures methods, Young Adult, Microsurgery methods, Adolescent, Aged, Magnetic Resonance Imaging, Hemangioma, Cavernous, Central Nervous System surgery, Cerebral Cortex surgery, Cerebral Cortex diagnostic imaging
- Abstract
Objective: Cerebral cavernous malformations (CMs) are pathological lesions that cause discrete cortical disruption with hemorrhage, and their transcortical resections can cause additional iatrogenic disruption. The analysis of microsurgically treated CMs might identify areas of "eloquent noneloquence," or cortex that is associated with unexpected deficits when injured or transgressed., Methods: Patients from a consecutive microsurgical series of superficial cerebral CMs who presented to the authors' center over a 13-year period were retrospectively analyzed. Neurological outcomes were measured using the modified Rankin Scale (mRS), and new, permanent neurological or cognitive symptoms not detected by changes in mRS scores were measured as additional functional decline. Patients with multiple lesions and surgical encounters for different lesions within the study interval were represented within the cohort as multiple patient entries. Virtual object models for CMs and approach trajectories to subcortical lesions were merged into a template brain model for subtyping and Quicktome connectomic analyses. Parcellation outputs from the models were analyzed for regional cerebral clustering., Results: Overall, 362 CMs were resected in 346 patients, and convexity subtypes were the most common (132/362, 36.5%). Relative to the preoperative mRS score, 327 of 362 cases (90.3%) were in patients who improved or remained stable, 35 (9.7%) were in patients whose conditions worsened, and 47 (13.0%) were in patients who had additional functional decline. Machine learning analyses of lesion objects and trajectory cylinder mapping identified 7 hotspots of novel eloquence: supplementary motor area (bilateral), anterior cingulate cortex (bilateral), posterior cingulate cortex (bilateral), anterior insula (left), frontal pole (right), mesial temporal lobe (left), and occipital cortex (right)., Conclusions: Transgyral and transsulcal resections that circumvent areas of traditional eloquence and navigate areas of presumed noneloquence may nonetheless result in unfavorable outcomes, demonstrating that brain long considered by neurosurgeons to be noneloquent may be eloquent. Eloquent hotspots within multiple large-scale networks redefine the neurosurgical concept of eloquence and call for more refined dissection techniques that maximize transsulcal dissection, intracapsular resection, and tissue preservation. Human connectomics, awareness of brain networks, and prioritization of cognitive outcomes require that we update our concept of cortical eloquence and incorporate this information into our surgical strategies. more...
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- 2024
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217. Complex Dysautonomia in a Patient With Cerebral Cavernous Malformations Due to a KRIT1 Pleiotropic Gene Mutation.
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Janssen R, Ariëns M, van Genugten J, Jacobi L, and Koek G
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Dysautonomia is a disruption of the body's autonomic processes. Symptoms vary among patients, depending on the underlying disease pathways. Given that symptoms can affect all organ functions, dysautonomia often significantly impacts quality of life. However, due to its complex and varied presentation, early recognition of dysautonomia remains a challenge, yet it is crucial for improving patient outcomes. We report a case of a patient with a KRIT1 mutation presenting with dysautonomia causing urological, sexual, and bowel dysfunction. We hypothesize that the patient's symptoms are due to a pontine cavernous malformation (CM) caused by the KRIT1 mutation. A literature review was conducted to establish a link between pontine CM and dysautonomia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Janssen et al.) more...
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- 2024
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218. Acute management of ruptured cavernous malformation of the optic nerve: illustrative case.
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Kawalec P, Del Bigio MR, and Kaufmann AM
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Background: A cavernous malformation of the optic nerve (CMON) is a rare condition that often presents with an abrupt decline in vision. Acute management of ruptured optic nerve cavernous malformations is generally surgical, although the timing of surgery is controversial., Observations: A 47-year-old female experienced the sudden loss of vision in her left eye. Examination showed that this eye was nearly blind, and her right eye had a temporal field defect. Neuroimaging showed hemorrhage in her left optic nerve and optic chiasm. She was taken to the operating room on an emergent basis where the optic canal was decompressed, the hemorrhage was evacuated, and a vascular malformation with features of a cavernoma was removed from the optic nerve. Over the next 2 days, the vision in her right eye significantly recovered., Lessons: CMONs remain rare, and it is unlikely that enough cases can be gathered to form a larger trial to compare the role and timing of surgery. On the basis of our experience with this case, the authors recommend that acute CMON-related hematomas should be treated as a surgical emergency and managed with acute optic nerve decompression, hematoma evacuation, and cavernoma resection to improve chances of vision recovery and prevent further vision loss. more...
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- 2024
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219. A taxonomy for superficial cerebral cavernous malformations: subtypes of cortical and subcortical lesions.
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Hendricks BK, Scherschinski L, Jubran JH, Karahalios K, Hickman MD, VanBrabant D, and Lawton MT
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- Humans, Female, Male, Adult, Middle Aged, Retrospective Studies, Young Adult, Cerebral Cortex pathology, Cerebral Cortex surgery, Adolescent, Aged, Neurosurgical Procedures methods, Child, Hemangioma, Cavernous, Central Nervous System surgery, Hemangioma, Cavernous, Central Nervous System pathology
- Abstract
Objective: A taxonomy for superficial cerebral cavernous malformations (CMs), those based cortically in gyral gray matter or subcortically in underlying white matter, is proposed to build on the comprehensive, systematic characterization of CMs in the entire brain., Methods: Patients with superficial cerebral CMs were retrospectively analyzed from a consecutive surgical series between November 2008 and June 2021 at the authors' center. Superficial cerebral CMs were categorized into 4 subtypes based on their cortical location or, if subcortical, proximity to the nearest cerebral surface: convexity, medial, basal, and sylvian. Lobar location was also included for subtyping: frontal, temporal, parietal, and occipital., Results: A total of 362 CMs were resected in 346 patients. CM subtypes were as follows: 132 (36.5%) convexity, 78 (21.5%) medial, 72 (19.9%) basal, and 80 (22.1%) sylvian. Frontal CMs were most common (155 [42.8%]), followed by parietal (89 [24.6%]), temporal (87 [24.0%]), and occipital (31 [8.6%]). Of all CMs, 302 (83.4%) were cortical and 60 (16.6%) were subcortical. The mean subcortical depth of deep lesions was 2.97 cm, and the mean lesion volume was 4.68 cm3. Overall, 228 lesions (63.0%) were resected through a transgyral approach, and 134 (37.0%) were resected through a transsulcal approach. Good outcomes (modified Rankin Scale [mRS] score ≤ 2) were observed in 314 patients (86.7%) and poor outcomes (mRS score > 2) in 25 patients (6.9%), and 23 patients (6.4%) were lost to late follow-up (mean follow-up duration 11.5 months). Relative outcomes were good (unchanged or improved mRS score) in 327 patients (90.3%) and poor (worse or died) in 35 patients (9.7%)., Conclusions: Superficial cerebral CMs were resected through a gyrus or sulcus to open the subarachnoid dissection corridors, traversing the full extent of sulci to deepen the approach and minimize tissue transgression. Transgyral dissection avoids associated arteries but is inherently transgressive, whereas transsulcal dissection preserves cortical tissue and may reduce morbidity. Superficial cerebral CMs occupy the largest territory of the 7 types, and the size and surface complexity of the cerebrum make taxonomic subtyping valuable for clear anatomical description. more...
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- 2024
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220. [Radiosurgery for cerebral cavernous malformations: a systematic review].
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Semenov DE, Belousova OB, Kostyuchenko VV, and Golanov AV
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- Female, Humans, Male, Hemangioma, Cavernous, Central Nervous System surgery, Hemangioma, Cavernous, Central Nervous System diagnostic imaging, Radiosurgery methods, Radiosurgery adverse effects
- Abstract
Background: Stereotactic radiosurgery (SRS) for cerebral cavernous malformations has been used for more than 30 years. However, indications for this method and outcomes are still discussable., Objective: To analyze available literature data on SRS for cerebral cavernous malformations with assessment of indications for treatment, radiation parameters, radiological and clinical complications and outcomes., Results: The final analysis included 20 reports describing post-SRS outcomes in 1834 patients with cerebral cavernous malformations. The main radiation parameter was mean radiation dose to the edge of cavernous malformation (prescribed dose, 13.25±2.16 Gy). In natural course of malformation, mean incidence of hemorrhages from cavernous malformation when counted after the second hemorrhage was 25.9±14.6%, after the patient's birth - 2.59±0.44%. Mean follow-up period after SRS was 66.7±24.1 months. Incidence of hemorrhages from cavernous malformation after SRS for the first 2 years of follow-up was assessed in 14 studies (4.67±3.51%). Incidence of hemorrhages ≥2 years after SRS was analyzed in 12 studies (1.55±0.8%)., Conclusion: Despite significant global experience in SRS for cerebral cavernous malformations and many studies devoted to this problem, clear patient selection criteria have not yet been formulated. Modern selection principles have insufficient evidence base. more...
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- 2024
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221. Brainstem Cavernomas, Accessible Lesions: Surgery
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Abla, Adib A., Spetzler, Robert F., Hayat, M. A., Series editor, and Hayat, M.A., editor
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- 2014
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222. Brain and Spine Injury and Cerebral Vascular Disorders
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Kim, Ji Hye and Kim, In-One, editor
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- 2014
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223. Vascular Malformations of the Central Nervous System
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Bradac, Gianni Boris and Bradac, Gianni Boris
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- 2014
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224. Intradural Spinal Cord Tumors
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Kalra, Ricky R., Dailey, Andrew T., Patel, Vikas V., editor, Patel, Alpesh, editor, Harrop, James S., editor, and Burger, Evalina, editor
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- 2014
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225. Cerebral Haemorrhage
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Saliou, Guillaume, Théaudin, Marie, Join-Lambert Vincent, Claire, Souillard-Scemama, Raphaëlle, Saliou, Guillaume, Theaudin, Marie, Join-Lambert Vincent, Claire, and Souillard-Scemama, Raphaelle
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- 2014
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226. The Hybrid Neurovascular Operating Room
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Ellis, Michael J., Smith, Edward R., Orbach, Darren B., and Jolesz, Ferenc A., editor
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- 2014
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227. Microscopic trans-cerebellar approach for infratentorial cavernous malformation near the lateral recess associated with developmental venous anomaly. Case report.
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Hoz, Samer S., Aktham, Awfa A., Bdaiwi, Hassan M., Khadim, Alyaa A., Jihan, Zainab A., and AbdulAzeez, Mohammed Maan
- Subjects
- *
HUMAN abnormalities , *TEACHING hospitals , *HOSPITAL emergency services , *CAVERNOUS hemangioma , *NEUROSURGERY - Abstract
Background: Reports showed the intimate association of the developmental venous anomaly with infra-tentorial cavernous malformation. This association has several clinical and surgical implications, sometimes this association will be a surgical challenge and affect the selection of the safest approach to the lesion. Surgery for infratentorial cavernoma is indicated for accessible symptomatic lesion only. Case scenario: we present a case of deep cerebello-pontine CM adjacent to the lateral recess, presented with acute clinical deterioration to the emergency department of the Neurosurgery Teaching Hospital in Baghdad, Iraq, with the only possible approach was Trans-cerebellar approach because of the medial location of the associated DVA. Conclusion: The association of developmental venous anomaly with infratentorial cavernous malformation has a pivotal role in selection the most appropriate and safe surgical approach which should be based upon the individualized patient anatomy and the location of the target lesion. [ABSTRACT FROM AUTHOR] more...
- Published
- 2019
- Full Text
- View/download PDF
228. Affected health domains in patients with brainstem cavernous malformations.
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Kumar, Shivram, Lanzino, Giuseppe, and Flemming, Kelly D.
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HUMAN abnormalities , *STANDARD deviations , *BRAIN stem , *QUALITY of life , *ANGIOMAS - Abstract
Background: Brainstem cavernous malformations (CM) carry high risks of hemorrhage and neurologic morbidity. While much is published on physical effects of brainstem CM, very little is known about these patients' quality of life. This study aimed to assess the quality of life PROMIS-29 health domains of brainstem CM patients and identify quality of life predictors. Methods: This was a cross-sectional study of adult patients with at least one brainstem CM identified by advertising on the Angioma Alliance website and from our institutional CM registry. A web-based questionnaire was administered and included self-reported information about the patient, cavernous malformation, residual clinical symptoms, and treatment. In addition, patients filled out the PROMIS-29 (version 1.0). The PROMIS-29 has 7 health domains and is standardized against the general population. We defined impaired quality of life as at least one out of 7 abnormal domains and used a 1 standard deviation cutoff for abnormal. We verified clinical and radiographic data to self-reported data in 28.8% of patients. Results: A total of 104 patients (mean age of 46.5 ± 11.5 years; 77.9% females) were recruited. Most (82.7%) reported at least one symptomatic hemorrhagic event and 36.5% reported at least 1 surgical procedure. At least one abnormal PROMIS domain was present in 64.4% of patients with fatigue (34.6%), anxiety (35.6%), social (28.2%), and physical (27.9%) domains being the most common. Among patients with a Rankin Score of 0–2, 55% had at least one abnormal domain. Gait difficulty, but not age, sex, or surgery predicted impaired quality of life. Conclusion: More than half of patients with brainstem CM have impaired quality of life. Fatigue, anxiety, and social function, in addition to physical dysfunction, are common; practitioners should be aware of these concerns. PROMIS-29 provides additional information than modified Rankin Score and should be considered in clinical trials and when assessing treatment outcomes until a disease-specific outcome tool is available. [ABSTRACT FROM AUTHOR] more...
- Published
- 2019
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229. Hemorrhage Risk of Untreated Isolated Cerebral Cavernous Malformations.
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Kearns, Kathryn N., Chen, Ching-Jen, Yagmurlu, Kaan, Capek, Stepan, Buell, Thomas J., Taylor, Davis G., Pomeraniec, I. Jonathan, Park, Min S., and Kalani, M. Yashar
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HEMORRHAGE , *HUMAN abnormalities , *LOG-rank test , *CAVERNOUS hemangioma , *PATIENT selection - Abstract
Predicting future hemorrhage risk may allow better selection of patients with cerebral cavernous malformations (CCMs) who will likely benefit from treatment. In this study, we sought to identify predictors of CCM hemorrhage, and to compare subsequent symptomatic hemorrhage risks between patients with and without previous hemorrhage. We performed a retrospective review of consecutive CCM patients at our institution between 1982 and 2017. Patients with diffuse or familial CCM syndromes, and those without follow-up data were excluded. The primary endpoint was acute symptomatic hemorrhage causing transient or permanent neurological symptoms. Primary endpoint incidences were compared between patients with and without previous hemorrhage. The study cohort comprised 84 patients with 90 CCMs. Previous hemorrhage was the only significant predictor for the primary endpoint (P = 0.003). CCMs with previous hemorrhage had a higher risk of symptomatic hemorrhage in follow-up than those without previous hemorrhage (26.9 vs. 1.5 symptomatic hemorrhages per 1000 CCM-months, P < 0.001). CCMs with and without previous hemorrhage had annual hemorrhage rates of 2.7% and 0.15%, respectively. Symptomatic hemorrhage-free survival rates were significantly lower in CCMs with previous hemorrhage (log-rank test, P < 0.001). Actuarial hemorrhage-free survival rates for CCMs with previous hemorrhage were 75%, 60%, 60%, and 60% at 1, 2, 3, and 4 years, respectively, compared with rates of 95%, 95%, 95%, and 84% for CCMs without previous hemorrhage. Previous hemorrhage is a predictor of subsequent symptomatic hemorrhage in CCMs. Compared with CCMs without previous hemorrhage, those with prior hemorrhage have a significantly higher risk of future symptomatic hemorrhage. [ABSTRACT FROM AUTHOR] more...
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- 2019
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230. بررسی نشانههاي بالینی مبتلایان به آنومالی وریدي عروق سیستم عصبی مرکزي
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مسعود غیاثیان, سجاد دانشیار, خالد کریمینژاد, and عباس مرادي
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Background: Venous anomalies are the most common vascular malformation of the central nervous system in adult, it can form anywhere in the body, but are most likely to cause symptoms when they grow in the brain or spinal cord. Common symptoms include headaches or seizures. Experiencing symptoms depend on where the lesions grow and how many of the lesions are present. Most of the time, these formations cause no problems. In some people, knowing the clinical signs and possible future complications in the disease can help to treat the disease and diagnose it. Methods: In this Prospective cohort study, 41 patients with cavernous malformation who were diagnosed by neurologist referred to Sina Hospital in Hamedan City, Iran, from 2016 to 2017 were studied. Patients' information about their referrals during the follow-up period were collected and the results were reported. Results: This study was conducted on 20 (48.79%) females and 21 (51.21%) males with the mean ages of 50±2 years. The most common manifestation of disease was seizure in 20 patients (48.78%). Most of these lesions were found in parietal lobe in 11 cases (26.82%) and then in the frontal lobe with 8 cases (19.51%). In terms of complications during follow-ups, 16 patients (39.2%) were uncomplicated, 16 patients had 48 episodes of seizure, seven patients had nine episodes of hemorrhage, two patients with hemiparesis, one patient with headache and one patient with sixth cranial nerve paralysis. According to the associated disease and risk factors, nine patients (26.82%) had high blood pressure, five patients (12.19%) had meningioma and three patients (7.31%) had diabetes. Seven patients (17.07%) had a positive family history that symptoms and complications in this patients are higher than the rest of patients. Conclusion: In this study, most of the cases are sporadic and the most common symptom was seizure. The most common symptom in supratentorial lesions were seizure whereas in multiple and infratentorial lesions were bleeding. Five patients were involved with meningioma which could be considered in more studies with more patients in future. [ABSTRACT FROM AUTHOR] more...
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- 2019
231. The transcallosal transchoroidal approach to the diencephalic-mesencephalic junction: how I do it.
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Cossu, Giulia, González-López, Pablo, and Daniel, Roy T.
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DIENCEPHALON , *MESENCEPHALON , *BRAIN function localization , *ANATOMY - Abstract
Background: Different approaches have to be considered for lesions of the diencephalic-mesencephalic junction based on the localization, extension of the lesion, and relationship to the ventricular system. Method: We present the case of a young lady who presented with a cavernoma of the junction of midbrain and diencephalon after an episode of hemorrhage. The microsurgical anatomy of the trans-callosal trans-choroidal approach for this lesion is described along with its advantages and limitations. Conclusion: The trans-choroidal approach allows adequate access to lesions of the diencephalic-mesencephalic junction that project into the third ventricle. [ABSTRACT FROM AUTHOR] more...
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- 2019
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232. Stereotactic Radiosurgery for Brainstem Cavernous Malformations: An Updated Systematic Review and Meta-Analysis.
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Kim, Byung Sup, Kim, Kyung Hwan, Lee, Min Ho, and Lee, Jung-Il
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STEREOTACTIC radiosurgery , *META-analysis , *BRAIN stem , *HUMAN abnormalities , *RADIATION doses - Abstract
This study was conducted to achieve more conclusive evidence for the efficacy of stereotactic radiosurgery (SRS) for brainstem cavernous malformations (BSCMs). A literature search of PubMed, EMBASE, and Web of Science was performed and studies reporting the outcomes of SRS for BSCMs were included. The primary outcome was the pre-SRS and post-SRS hemorrhage rates; the pooled incidence rate ratio (IRR) with 95% confidence interval was chosen as effect size. Lesion control, symptom change, and radiation-related complications were evaluated. A total of 576 patients across 14 studies were included in this meta-analysis. The post-SRS hemorrhage rate was significantly decreased compared with the pre-SRS rate (IRR, 0.123; P < 0.001), and the hemorrhage rate 2 years after SRS was significantly lower than that within 2 years after SRS (IRR, 0.317; P < 0.001). Ten among 14 studies have shown that the symptoms were improved or stationary after SRS. Lesion volume was reduced in 47.3% of the patients and was stationary in 49.4% on the last follow-up images. Symptomatic adverse radiation effects (AREs) developed in 7.3% and permanent AREs were observed in 2.2%. In subgroup analysis, studies having mean marginal dose of ≤13 Gy showed statistically significantly lower development of symptomatic AREs than those having mean marginal dose of >13Gy (2.0% vs. 10.8%; P = 0.008). SRS using a relatively low marginal dose can be a safe and effective treatment for BSCM. Further prospective studies are necessary to confirm the optimal radiation dose and efficacy of SRS for BSCMs. [ABSTRACT FROM AUTHOR] more...
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- 2019
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233. Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage: Analysis of Factors Influencing Clinical Presentation.
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Agosti, Edoardo, Flemming, Kelly D., and Lanzino, Giuseppe
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FACTOR analysis , *HEMORRHAGE , *HUMAN abnormalities , *CAVERNOUS hemangioma , *TEMPORAL lobe , *REGRESSION analysis - Abstract
Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. We queried a prospective registry of consecutive patients with CM established in January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with P values, odds ratios, and 95% confidence intervals reported. Of 202 patients, 58.4% were women, and the average age at diagnosis was 43.7 ± 16.5 years. Of the patients, 59.4% were symptomatic. In 40.6%, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 ± 14.6 years, and 56.7% were women. Compared with incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared with other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful. [ABSTRACT FROM AUTHOR] more...
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- 2019
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234. Developmental venous anomalies and brainstem cavernous malformations: a proposed physiological mechanism for haemorrhage.
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Maish, William N
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AUTONOMIC nervous system , *CENTRAL nervous system , *HUMAN abnormalities , *VENOUS pressure , *CAVERNOUS hemangioma , *JUGULAR vein - Abstract
The incidental diagnosis of both developmental venous anomalies (DVAs) and cavernous malformations (CMs) in the central nervous system is increasing with improved imaging techniques. While classically silent diseases, these cerebrovascular pathologies can follow an aggressive course, particularly when present in the brainstem. In the last decade, substantial research has focussed on KRIT1-mediated tight junction gene expression and their role in CM development. However, our understanding of the physiologic conditions precipitating symptomatic CM development or CM haemorrhage with and without concomitant DVAs, remains lacking. The only established risk factor for CM haemorrhage is a previous history of haemorrhage, and literature currently reports trauma as the only precipitant for symptomatic events. While plausible, this occurs in a minority, with many patients experiencing occult events. This manuscript presents a hypothesis for symptomatic CM events by first discussing the anatomical pathways for intracranial venous outflow via the internal jugular veins (IJV) and vertebral venous plexus (VVP), then exploring the role of venous flow diversion away from the IJVs under physiologic stress during dynamic postural shift. The resultant increase in intracranial venous pressure can exacerbate normal and pre-existing structural DVA pathologies, with repeated exposure causing symptomatic or CM-inducing events. This pathophysiological model is considered in the context of the role of the autonomic nervous system (ANS) in postural intracranial venous outflow diversion, and how this may increase the risk of DVA or CM events. It is hoped that this hypothesis invokes further investigation into precipitants for DVA or CM events and their sequela and, also, furthers the current knowledge on pathophysiological development of DVAs and CMs. [ABSTRACT FROM AUTHOR] more...
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- 2019
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235. Extra-Axial Cavernoma of the Cerebellopontine Angle: A Case Study and Review of Literature.
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Tarabay, Antonio, Rocca, Alda, Maeder, Philippe, Simonin, Alexandre, Messerer, Mahmoud, and Daniel, Roy Thomas
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CEREBELLOPONTILE angle , *LITERATURE reviews , *TRIGEMINAL nerve , *CRANIAL nerves - Abstract
Extra-axial cavernoma (EAC) at the cerebellopontine angle (CPA) is a rare clinical entity that can mimic radiologically several lesions encountered at this location. We report a case of EAC-CPA and present a review of the literature. A PubMed research was conducted looking for EAC-CPA lesions described in literature. After reviewing all the relevant articles, the following data were extracted and organized into a single table: patients' symptoms, radiological characteristics, surgical procedure, histopathology, and outcome. Eighteen cases (including ours) were identified from these reports. Mean age at diagnosis was 42 with a male:female ratio of 2.6:1. The most commonly involved cranial nerves were the vestibulocochlear complex followed by the trigeminal nerve. The lesions were iso-to hypodense on computed tomography. On magnetic resonance imaging, the EAC-CPA can be solid or cystic. All lesions were approached using retrosigmoid craniotomies. Histologically, both intra- and extra-axial cavernomas are identical, consisting of devoid vascular sinusoids with endothelial lining. The outcome was favorable in 16/18 of the described cases. One case presented a worsened facial paresis and 1 patient died from excessive intraoperative bleeding and subsequent complications. Despite the fact that EAC-CPA are rarely encountered, it should be kept in mind in the list of differential diagnosis, preparing both the surgeon and anesthesiologist for the surgery of a vascular lesion. Specific radiological features, especially an associated developmental venous anomaly could point to the diagnosis. [ABSTRACT FROM AUTHOR] more...
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- 2019
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236. Intraparenchymal extravasation of gadolinium mimicking an enhancing brain tumor.
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Ritchie, David J, Li, Charles Q, Hoshide, Reid, and Vinocur, Daniel
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Gadolinium (Gd)-enhanced magnetic resonance imaging plays an essential role in the detection, characterization, and staging of intracranial neoplasms and vascular abnormalities. Although Gd is helpful in a majority of situations, it can lead to diagnostic misinterpretation in the setting of active vascular extravasation. Scarce reports of intracranial extravasation of Gd are present in the literature. Here, we report the first case of surgically proven spontaneous intraparenchymal extravasation of Gd mimicking an enhancing intra-axial neoplasm in a pediatric patient. Early and accurate recognition of Gd extravasation is critical in obtaining the accurate diagnosis and triaging patients expeditiously into proper avenues of care. [ABSTRACT FROM AUTHOR] more...
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- 2019
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237. Cavernous malformation of a thoracic spinal nerve root: Case report and review of literature.
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Vicenty, Juan, Fernandez-de Thomas, Ricardo, Estronza, Samuel, Mayol-Del Valle, Miguel, and Pastrana, Emil
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SPINAL nerve roots , *CAVERNOUS hemangioma , *DURA mater , *LITERATURE reviews , *SPINAL nerves , *HUMAN abnormalities - Abstract
Intradural extramedullary spinal cavernous malformations (CMs) remain the least common variant of these lesions and can originate from the inner surface of the dura mater, the pial surface of the spinal cord, and the blood vessels in the spinal nerves. Root-based-only extramedullary CMs are very rare in the thoracic region with only four cases reported. We present a case of 56-year-old male with 1-year progression of lower extremities weakness. Magnetic resonance imaging demonstrated a hyperintense lesion in the upper thoracic region. Surgical exploration revealed a CM with origin in the second thoracic nerve root with gross total resection. Histopathological examination confirmed a CM. The patient had complete recovery of neurological function at 3 months interval. Intradural extramedullary CM is extremely rare entity that must be considered in the differential diagnosis of intradural extramedullary lesions. Surgical resection is the treatment of choice to prevent further neurological damage. [ABSTRACT FROM AUTHOR] more...
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- 2019
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238. Temporal Lobe Cavernous Malformation Caused Epileptic Amnesic Episodes and Mild Cognitive Impairment.
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Hirokawa, Yusuke, Fujimoto, Ayataka, Ichikawa, Naoki, Sato, Keishiro, Tanaka, Tokutaro, Enoki, Hideo, Otsuki, Yoshiro, and Okanishi, Tohru
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TEMPORAL lobe ,MILD cognitive impairment ,PSYCHOGENIC nonepileptic seizures ,CAVERNOUS hemangioma ,AMYLOID plaque ,HUMAN abnormalities ,ALZHEIMER'S disease - Abstract
Neuropathological features in Alzheimer's disease (AD) are amyloid β (Aβ) deposits and neurofibrillary changes. AD is characterized by memory impairment and cognitive dysfunction, with some reports associating these impairments with hyperexcitability caused by Aβ in the medial temporal lobe. Epileptic seizures are known to be common in AD. We encountered a 65-year-old patient with cavernous malformation (CM) in the right temporal lobe who exhibited epileptic amnesia (EA) and AD-like symptoms. Scalp electroencephalography (EEG), including long-term video-EEG, showed no interictal discharges, but intraoperative subdural electrode (SE) recording from the right parahippocampal area showed frequent epileptiform discharges. Neuropathologically, senile plaques were found in the surrounding normal cortex of the CM. Postoperatively, the patient has remained free of EA and AD-like symptoms since total removal of the CM. This is the first surgical case report to confirm temporal lobe hyperexcitability associated with EA and AD-like symptoms. [ABSTRACT FROM AUTHOR] more...
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- 2019
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239. Hemorrhage, Seizures, and Dynamic Changes of Familial versus Nonfamilial Cavernous Malformation: Systematic Review and Meta-analysis.
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Taslimi, Shervin, Ku, Jerry C., Modabbernia, Amirhossein, and Macdonald, R. Loch
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META-analysis , *HEMORRHAGE , *HUMAN abnormalities , *CONFIDENCE intervals , *NATURAL history - Abstract
Cerebral cavernous malformations (CCMs) may be familial or nonfamilial. This systematic review compared the natural history of CCMs in familial compared with nonfamilial cases. We searched MEDLINE, Web of Science, and EMBASE for natural history studies on CCMs up to September 2018. We included studies that followed at least 20 untreated patients. Primary outcomes were hemorrhage, seizures, and neuroimaging changes in familial and nonfamilial cases. Incidence rate per person-year (PY) or lesion-year (LY) of follow-up were used to pool the data using fixed-effects or random-effects models. We used the incidence rate ratio for comparison. We could not compare hemorrhage rates between familial and nonfamilial cases mainly owing to mixtures of subgroups of patients. The seizure rate was similar in familial and nonfamilial cases with pooled incidence rate of 1.5%/PY (95% confidence interval 1.1%–2.2%). The reseizure rate was higher than the seizure rate (P < 0.001). New lesion development was higher in familial cases (32.1%/PY vs. 0.7%/PY, P < 0.001). Signal change on neuroimaging ranged from 0.2%/LY to 2.4%/LY in familial cases. In familial cases, incidence rate of size change was 8%/PY (95% confidence interval 5.2%–12.2%) and 1.1%/LY (95% confidence interval 0.6%–1.6%). Familial CCMs show higher dynamic changes than nonfamilial cases. However, the presence of actual dynamic changes needs further assessment in nonfamilial cases. CCMs demonstrate a low incidence of seizure. First-time seizure increases the chance of recurrent seizure. Seizure rate based on the location and type of the lesion should be investigated further. [ABSTRACT FROM AUTHOR] more...
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- 2019
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240. Infratentorial Developmental Venous Abnormalities and Inflammation Increase Odds of Sporadic Cavernous Malformation.
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Kumar, Shivram, Lanzino, Giuseppe, Brinjikji, Waleed, Hocquard, Kate W., and Flemming, Kelly D.
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Goal: Sporadic brain cavernous malformations commonly correlate with developmental venous anomalies; however, developmental venous anomalies may exist without cavernous malformations. Infratentorial location and specific angioarchitectural features of the developmental venous anomaly increase the odds of a concomitant malformation. Animal data also suggest chronic inflammatory disease, oxidative stress, and angiogenesis promote cavernous malformation development. We sought to determine potential clinical and radiologic factors promoting development of sporadic cavernous malformations.Methods: One hundred and forty-five patients with sporadic, nonradiation-induced brain cavernous malformations (63 with radiologic-apparent and 82 with radiologic-occult developmental venous anomalies) were compared to developmental venous anomaly controls without associated malformation. Data collection included demographic information, comorbidities, medications at diagnosis, and location of the developmental venous anomaly and/or malformation. Logistic regression with likelihood ratios, odds ratios and 95% confidence intervals were calculated comparing malformation cases with controls. A similar analysis compared malformations with radiologic-apparent anomalies to controls.Results: Compared to controls, cases were more likely to have had a major infectious illness (10.3% versus 2.3%; P = .0003 and/or chronic inflammatory disease (31.7% versus 21.3%; P = .0184) prior to diagnostic magnetic resonance imaging. Infratentorial location was more common in cavernous malformation cases (31.7% versus 15.7% controls; P ≤ .0001) with similar findings in cavernous malformation with radiologic-apparent developmental venous anomalies versus controls.Conclusions: Infratentorial developmental venous anomalies location, major infectious illness, and chronic inflammatory disorders increase the odds of sporadic cavernous malformation formation. Inflammation may promote local thrombosis of developmental venous anomalies, trigger angiogenic response through increased vascular permeability, or promote cavernous malformation through Toll-like receptor 4. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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241. Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations.
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Goyal, Anshit, Rinaldo, Lorenzo, Alkhataybeh, Redab, Kerezoudis, Panagiotis, Alvi, Mohammed Ali, Flemming, Kelly D., Williams, Lindsy, Diehn, Felix, and Bydon, Mohamad
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ANGIOMAS ,SPINAL cord ,NATURAL history ,CAVERNOUS hemangioma ,HUMAN abnormalities - Abstract
Objective: There is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management.Methods: We retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates.Results: A total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1-12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013).Conclusion: Large, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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242. Defining Long-Term Clinical Outcomes and Risks of Stereotactic Radiosurgery for Brainstem Cavernous Malformations.
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Jacobs, Rachel, Kano, Hideyuki, Gross, Bradley A., Niranjan, Ajay, Monaco III, Edward A., and Lunsford, L. Dade
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RADIOSURGERY , *STEREOTACTIC radiosurgery , *BRAIN stem , *HUMAN abnormalities , *UNIVARIATE analysis , *MULTIVARIATE analysis , *CONFIDENCE intervals - Abstract
Background We evaluated clinical outcomes in patients with symptomatic brainstem cavernous malformations (CMs) treated by stereotactic radiosurgery (SRS). Methods Between 1988 and 2016, Gamma Knife SRS was performed in 76 evaluable patients with solitary symptomatic brainstem CMs. Forty-nine (66%) were intrinsic (not reaching a pial or ependymal surface). Most patients (91%) had experienced 2 or more hemorrhages associated with new neurologic deficits. Fourteen patients (18%) underwent resection before radiosurgery. The median CM volume was 0.66 cm3 (range, 0.05–6.8), and the median margin dose was 15.0 Gy. Results After SRS, 15 patients (20%) had an imaging confirmed new hemorrhage at a median follow-up of 48 months. The hemorrhage-free survival after SRS for brainstem CMs was 92% at 1 year, 87% at 3 years, and 85% at 5 years. The annual hemorrhage rate was 31% before and 4% after SRS. In univariate analysis, CM volume, previous surgical resection, and increased number of hemorrhages before SRS were significantly associated with a higher rate of hemorrhage after SRS. In multivariate analysis, only number of previous hemorrhages was significant (P < 0.0005; hazard ratio, 1.51, 95% confidence interval, 1.23–1.85). Symptomatic adverse radiation effects developed in 7 patients (9%). The rate of symptom deterioration related to hemorrhage or symptomatic adverse radiation effects was 10% at 1 year, 18% at 3 years, and 20% at 5 years. Conclusions Patients with an increased rate of hemorrhage before SRS had an increased risk of repeat hemorrhage and symptom deterioration rate after SRS. Intrinsic CM location did not significantly affect rates of symptom deterioration or rebleeding. [ABSTRACT FROM AUTHOR] more...
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- 2019
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243. Surgical treatment of an asymptomatic giant supratentorial cavernous hemangioma. Case report.
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Villalonga, Juan F., Saenz, Amparo, and Campero, Alvaro
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Highlights • GCMs are rare, and because of their large size and the variation on their images, the diagnosis is challenging. • Prognostic factors and treatment for CM are well known. • The same does not apply to GCM because of the unpredictable behavior of these type of lesions. • An unusual case of an asymptomatic GCM is presented. • To our knowledge, this is the first case of an asymptomatic GCM presented in the literature, which raises the question about which the appropriate treatment is. Abstract A case is reported of a 19-year old patient with a supratentorial giant cavernous malformation (GCM). This was an incidental finding in the context of acute head trauma. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a giant supratentorial right mass. Surgical excision was performed, and histopathology findings were consistent with a cavernous malformation (CM). The patient had a complete neurological recovery. To our knowledge, this is the first case of a GCM in an asymptomatic patient with total surgical excision. [ABSTRACT FROM AUTHOR] more...
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- 2019
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244. Surgical Management of Brainstem Cavernous Malformation: Report of 67 Patients.
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Gui, Songbai, Meng, Guolu, Xiao, Xinru, Wu, Zhen, and Zhang, Junting
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CAVERNOUS hemangioma , *DIPLOPIA , *APHASIA , *HEMORRHAGE , *BRAIN stem , *DISEASES , *HUMAN abnormalities - Abstract
Background Brainstem cavernous malformations (CMs) are benign lesions, often show an acute onset, and result in a high rate of morbidity. Surgical resection could inhibit the progressive deterioration of neurologic function caused by repetitive hemorrhage. This study aimed to summarize timing, approaches, and techniques of surgery and to evaluate outcomes of treatment. Methods Between March 2011 and May 2013, 67 patients (32 male, 35 female; average age 40 years; range, 14–68 years) with brainstem CMs received surgical treatment. Clinical presentation, surgical approaches, and results of follow-up were retrospectively analyzed. Results Seven surgical approaches were used: orbitozygomatic approach (1 case), suboccipital transtentorial approach (Poppen approach; 3 cases), subtemporal transtentorial approach (32 cases), subtemporal transtentorial/anterior petrosectomy approach (9 cases), suboccipital retrosigmoid approach (3 cases), midline suboccipital approach (16 cases), and far lateral approach (3 cases). Total resection of the brainstem CM was achieved in all cases (100%). No operative mortality was encountered. Nine patients had new symptoms after surgery: 3 had diplopia, 3 had facial numbness, 1 had numbness of contralateral limbs, 1 had transient aphasia, and 1 had reduced muscle strength of contralateral limbs. Symptoms significantly improved in 23 patients (34.3%), symptoms were unchanged in 36 patients (53.7%), and new postoperative symptoms occurred in 9 patients (13.4%). Conclusions Choosing a proper surgical approach and using appropriate techniques are fundamental for favorable outcomes of patients with brainstem CMs. [ABSTRACT FROM AUTHOR] more...
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- 2019
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245. Anatomical and Objective Evaluation of the Main Surgical Approaches to Pontine Intra-Axial Lesions.
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Cavalcanti, Daniel D., Figueiredo, Eberval G., Preul, Mark C., and Spetzler, Robert F.
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SURFACE area , *CELL nuclei , *CRANIAL nerves , *QUANTITATIVE research - Abstract
Objective Apparently similar intra-axial pontine lesions may demand distinct surgical approaches. Selecting the optimal approach reduces unnecessary manipulation of tracts and nuclei. This study aims to reveal a quantitative analysis of main surgical corridors dealing with intrinsic pontine pathology. Methods Six approaches were performed repeatedly in 10 cadaveric heads: 1) retrosigmoid, 2) retrolabyrinthine, 3) subtemporal transtentorial, 4) anterior petrosectomy, 5) combined petrosal approach, and 6) suboccipital telovelar. Six safe entry zones were studied: peritrigeminal, supratrigeminal, lateral pontine, supracollicular, infracollicular, and median sulcus of fourth ventricle. A neuronavigation device was used to collect 3-dimensional coordinates from fixed points over the edge of craniotomies and brainstem surface; 4 variables were studied: 1) angles of attack; 2) areas of exposure; 3) lengths of exposure; and 4) trajectories. Results The mean area of exposure generated by the retrosigmoid approach over the brainstem was 538.6 ± 161.0 mm2, whereas that yielded by the retrolabyrinthine was 475.0 ± 173.4 mm2. There were no significant differences between both when considering areas of exposure and angles. Adding a tentorial cut to the subtemporal approach exposed the superior part of the lateral surface of pons; the area of exposure increased a mean of 33% (P < 0.001). Conclusions In addition to producing similar areas and angles of attack, the retrolabyrinthine yields a more orthogonal trajectory to lateral pons than the retrosigmoid approach. Adding a tentorial cut and anterior petrosectomy significantly increased areas and lengths of exposure of a regular subtemporal approach. The combined approach significantly increased angles of attack to both the supratrigeminal and lateral pontine safe zones. Highlights • Quantitative data of the main surgical approaches to pons are provided. • No significant differences were found in areas produced by retrosigmoid and retrolabyrinthine. • Mean distance between origin of cranial nerves V and VII, approaching the lateral pontine zone, was 7.1 mm. • Dividing the tentorium produced a mean gain of 6.9 mm (P < 0.001) in vertical exposure. • The combined approach significantly increased angles to the supratrigeminal and lateral pontine zones. [ABSTRACT FROM AUTHOR] more...
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246. De novo cavernous malformation arising in the wall of vestibular schwannoma following stereotactic radiosurgery: case report and review of the literature.
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Nussbaum, Leslie A., Nussbaum, Eric S., Kallmes, Kevin M., Bellairs, Ellen, and McDonald, William
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We report a novel case of a radiation-induced cavernous malformation developing in a vestibular schwannoma previously treated with stereotactic radiosurgery. Eleven years after treatment, the patient presented with a large predominantly cystic lesion in the cerebellopontine angle. We performed surgery, and a solid vascular lesion was identified within the schwannoma, which was determined to be a cavernous malformation after histopathological analysis. We review the literature of radiation-induced cavernous lesions, illustrating that while rare, these lesions do pose concern as a long-term complication of brain radiation therapy. We also discuss the possibility that radiation-induced cavernous malformation-like lesions are pathologically distinct from cavernous malformations. [ABSTRACT FROM AUTHOR] more...
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- 2019
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247. Cavernous malformations are rare sequelae of stereotactic radiosurgery for brain metastases.
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Samghabadi, Peyman, Cho, Nam, Choi, Clara Y. H., Soltys, Scott G., Seiger, Kira, Pendharkar, Arjun V., Chang, Steven D., Wang, Candace, and Gephart, Melanie Hayden
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The development of cavernous malformations many years following conventionally fractionated brain irradiation is well recognized and commonly reported. However, cavernous malformation induction following stereotactic radiosurgery (SRS) is largely unreported. Herein, we describe two cases of cavernous malformation formation years following SRS for brain metastases. A 20-year-old woman with breast cancer brain metastases received treatment with whole brain radiotherapy (WBRT), then salvage SRS 1.4 years later for progression of a previously treated metastasis. This lesion treated with SRS had hemorrhagic enlargement 3.0 years after SRS. Resection revealed a cavernous malformation. A 25-year-old woman had SRS for a brain metastasis from papillary thyroid carcinoma. Resection of a progressive, hemorrhagic lesion within the SRS field 2 years later revealed both recurrent carcinoma as well as cavernous malformation. As patients with brain metastases live longer following SRS, our cases highlight that the differential diagnosis of an enlarging enhancing lesion within a previous SRS field includes not only cerebral necrosis and tumor progression but also cavernous malformation induction. [ABSTRACT FROM AUTHOR] more...
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- 2019
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248. Coexistent cerebral cavernous malformation and developmental venous anomaly: Does an aggressive natural history always call for surgical intervention?
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Das, Kuntal, Rangari, Kamlesh, Singh, Suyash, Bhaisora, Kamlesh, Jaiswal, Awadhesh, and Behari, Sanjay
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MAGNETIC resonance imaging , *NATURAL history , *ANGIOMAS , *HUMAN abnormalities , *CAVERNOUS hemangioma , *ANGIOGRAPHY - Abstract
Coexistence of cerebral cavernous malformations (CMs) and developmental venous anomaly (DVA) represents the most common form of mixed intracranial vascular malformations. Existing literature supports not only a possible causative role of DVA for de novo CMs but also a potentially detrimental effect on an associated CM, increasing the chances of hemorrhagic complications and growth in the latter. A 52-year-old gentleman presented to us with a 17-year long history of simple motor seizures on the left faciobrachial region. On magnetic resonance imaging (MRI) of the head, a 1.5 cm × 1.5 cm CM without any evidence of recent hemorrhage was identified in the left high frontal premotor area. There was a linear enhancement in the adjoining superior frontal sulcus on contrast MRI. On intra-arterial angiogram, this hyperintensity was confirmed to be a venous channel draining into the superior sagittal sinus. Thus, a diagnosis of cavernoma associated with a DVA was made. The patient was advised conservative treatment and he was doing well at follow-up. Unless diligently looked for, DVA associated with CM may be easily missed. The coexistence has pathophysiological and management implications. Despite the reported aggressive natural history, there is a scope for conservative treatment for these complex vascular malformations. [ABSTRACT FROM AUTHOR] more...
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- 2019
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249. Management and surgical approaches of brainstem cavernous malformations: Our experience and literature review.
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Cannizzaro, Delia, Sabatino, Giovanni, Mancarella, Cristina, Revay, Martina, Rossi, Marco, Pecchioli, Guido, Cardia, Andrea, Maira, Giulio, D'Angelo, Vincenzo, and Fornari, Maurizio
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LITERATURE reviews , *SURGICAL indications , *BRAIN stem , *OPERATIVE surgery , *HUMAN abnormalities , *ANGIOMAS , *CAVERNOUS hemangioma - Abstract
Introduction: Brainstem cavernous malformations (BSCMs) are clusters of dilated sinusoidal channels. Clinical presentation is characterized by focal neurological deficits and/or hemorrhage. The goal of this study is to analyze surgical indications and approaches in a series of patients with BSCM and review pertinent literature and suggest prognostic factors related to the anatomical, clinical, and surgical data collected. Methods: We retrospectively reviewed the clinical data of 55 patients with BSCM, treated at three centers, from January 2006 to March 2016. We collected anagraphic data, pre and postoperative neurological status, pre and postradiological images, surgical procedures, and follow-up results. We summarized the anatomical, clinical, and surgical aspects of the lesions and identified two large groups based on the chosen approach: lateral and medial. Clinical and radiological results were then compared. Results: The series comprised 55 patients. Hemorrhagic onset was observed in all patients. Suboccipital, retrosigmoid, anterior, subtentorial, subtemporal, transvermian, telovelar, far lateral and trans, and infratentorial approaches were performed. Neurological status improved postoperatively in 34 cases at last follow-up. Five patients showed clinical neurological worsening. Total resection was achieved in 46 cases and, during a mean follow-up of 63.4 months, no recurrence or re-bleeding occurred in those patients. The mean follow-up was 63.9 months. The mean modified Rankin Scale at final follow-up was used to analyze the results and draw our conclusions. Conclusions: A reasonable surgical approach, selection, and gentle handling of the surrounding structures are required to prevent impairment of neurologic function and avoid partial resection. [ABSTRACT FROM AUTHOR] more...
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- 2019
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250. Recovery of consciousness after a brainstem cavernous malformation hemorrhage: A descriptive study of preserved reticular activating system with tractography.
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Ordóñez-Rubiano, Edgar G., Johnson, Jason M., Younus, Iyan, Avila, Mauricio J., Fonseca-Mazeau, Pierre Y., Marín-Muñoz, Jorge H., Cortes-Lozano, William, Enciso-Olivera, César O., and Ordóñez-Mora, Edgar G. more...
- Abstract
Highlights • An elegant description of the ARAS fiber tracts is presented. • A deviation and deformation of the dorsal raphè tracts is documented. • Clinical and radiological correlation is described for recovery of consciousness. Abstract The aim of this study is to describe the imaging features, the relevant anatomy, and the fractional anisotropy (FA) values in diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS) fiber tracts in 2 patients who recovered from initial altered consciousness after presenting with a brainstem cavernous malformation (BSCM) hemorrhage. A DTT was performed in 2 patients with impaired consciousness after a brainstem cavernous malformation hemorrhage. A 1.5 T scanner was used to obtain the axial tensors. Post-processing was performed and the mean FA values were recorded. The FA maps were used to seed the following regions of interest: the ventromedial midbrain, the anterior thalamus bilaterally, and the hypothalamus bilaterally. The first case presented with posterior displacement of the dorsal raphè fiber tracts, with preservation of all the ascending reticular activating fiber tracts and spontaneous recovery of consciousness after 20 days. The second case presented with no destruction but also had posterior displacement of the inferior dorsal raphè fiber tracts, with recovery of consciousness 1 month after resection surgery. Described in this study are affected fibers of the ARAS, as well as the FA value abnormalities in 2 patients, with recovery of a transient disorder of consciousness after a BSCM hemorrhage. [ABSTRACT FROM AUTHOR] more...
- Published
- 2019
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