Cavernoma gigante: relato de dois casos

Abstract

RESUMO -Angiomas cavernosos ou hemangiomas ou ainda cavernomas são malformações do sistema nervoso central, classificadas como lesões cerebrais vasculares ocultas, frequentemente assintomáticas, sendo relativamente raras. Definidas histologicamente como massas compactas cavernosas ou canais sinusoidais de vários tamanhos, com paredes finas no interior do parênquima cerebral e sem intervenção do tecido glial. Podem ocorrer em qualquer faixa etária inclusive em neonatos. Na maioria das vezes são lesões de tamanho reduzido, localizadas no interior do parênquima encefálico. Angiograficamente não mostram alterações com circulação patológica, podendo mesmo não ser diagnosticados pela tomografia, sendo o exame ideal para o seu diagnóstico a ressonância magnética de crânio. Os cavernomas são lesões histologicamente benignas mas, dependendo de sua localização, podem trazer grandes transtornos neurológicos e ser irressecáveis. A exérese cirúrgica da lesão é o tratamento de escolha se a lesão for única e em localização favorável e estiver desencadeando sintomatologia neurológica prejudicial ao paciente. Apresentamos dois casos de cavernomas gigantes que apresentaram boa evolução após ressecção cirúrgica completa. Descritos como gigantes, foram encontrados apenas três casos individuais na literatura .PALAVRAS-CHAVES: cavernoma, angioma cavernoso gigante.Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases ABSTRACT -Cavernous angiomas or haemangiomas or yet cavernomas are malformations of the central nervous system classified as occult vascular brain lesions. These rare lesions are clinically silent. They are defined by the presence of abnormally large vascular cavities or sinusoids channels of variable size, with sharp walls, located inside but not invading the brain parenchyma. They can occur at any age, including the neonatal period. Most of the small lesions are located inside the brain parenchyma. No abnormal circulation can be demonstrated in angiography and CT scan can be helpful for diagnosis only in rare occasions. Magnetic resonance is the best exam to demonstrate the lesion. Despite the benign character some lesions may cause neurologic dysfunction when their removal may be difficult. Complete extirpation is the best treatment if the lesion is favorable located and is causing neurological dysfunction. Two cases of giant cavernomas with good outcome after total removal are present. Only three cases of giant cavernomas were reported in the literature.KEY WORDS: cavernoma, giant cavernous angioma.Cavernomas intracerebrais são malformações vasculares raras, angiograficamente ocultas 1 , com características histopatológicas próprias e distintas de outras malformações vasculares cerebrais (Tabela 1) 2 . De acordo com Russel e Rubinstein 3 , 75% são supratentoriais, podendo acometer qualquer lobo do cé-rebro. Apresentam localização preferencial na regi...

Cavernous angioma of the cavernous sinus: imaging findings

“…Extra-axial cavernous angiomas are uncommon, and the cavernous sinus is one location in this group. It is most common in women in their fifth decade of life and in Japanese people, being rarely multiple and hereditary (specially in Hispanic-American subjects) [1][2][3][4][5][6][7][8] . It is, in fact, a vascular malformation, which can behave like a real tumor when it grows up to the point to compress neighbor structures.…”

“…Calcification is an occasional finding, and it is most common in meningiomas 5,6,8 . Erosion of the sphenoid bone can also be seen.…”

“…Although parenchymal cavernomas are easily resected in most cases, surgical excision of cavernous angiomas is often challenging because of abundant operative bleeding, due to the vascular nature of these lesions [3][4][5]7,8,10 . Predominantly vascular masses and mostly organized ones can be found 9 .…”

Giant Cavernous Malformation : A Case Report and Review of the Literature

“…Although patients with CMs typically present between the second and fourth decades 1,5,12,22,25) , the majority of GCMs has occurred in children, with youngest one being 3.5 months of age 3,4,[8][9][10][11]24) . The overall prevalence among males and females is equal in the majority of CMs 5,20) , but, in GCMs, there seem to be a female preponderance 24) .…”

“…Giant Cavernous Malformation｜DW Son, et al Our case also presented with seizure. But, presenting a large intracranial mass with signs of increased intracranial pressure in children was reported in some cases 4,8,10,11,24) . Hemorrhage of the CMs is reported to be 8% to 37% in adults and 36% to 78% in children 16,17) .…”