Cerebellar cavernous malformations: systematic review of the literature

Abstract

I n t roduction: C e rebellar cavernous malform a t i o n s a re rarely described in largest series ranging 1,2 to 1 1 , 8 % of all intracranial cases and 9,3 to 52,9% of infratentorial cases. However, cavernous malformations localized in the cerebellum are limited to case re p o rts and perc e ntage citations of this location among all localizations and infratentorial cavernous malformations. Consequently, epidemiological, clinical, radiological and therapeutical data about cerebellar cavernous malformations are unpublished since these lesions are analyzed together with others infratentorial cavernous malformations which have specific features and, therefore, can not be reference for all infratentorial cavernous malformations. Objective: To analyze the epidemiological, clinical, radiological and therapeutical features of the cerebellar cavernous malformations and compare it with the intracranial cavernous malformations features, so as to define their specificities. Method: A systematic review of the literature on c e rebellar cavernous malformations, starting from 1950, identified 92 bibliographical references, adding a total of 270 cases. Of these, 94 cases had their data clearly described. They were analyzed together with 6 new cases from a retrospective review of cavernous malformations surgically treated at the Division of Neuro s u rg e ry of UNIFESP-EPM, resulting in a total of 100 cases of cerebellar cavernous malformations, which were conside red to the following aspects: gender, age, clinical pre sentation, image diagnosis, treatment and evolution. Results: No relation to gender was found; incidence was lower from the age of 61; 87% of the cases were THESES symptomatic; the lesion Type II of Zabramski et al (1994) was the most frequent occurring in 60% of the cases; the location at cerebellar hemispheres was more fre q u e n t than in the vermis, without side preference; the lesions w e re classified as small (40%), medium (30%) and larg e (30%); the treatment was conservative (20%), surgery (74%) and radiosurg e ry (6%); the evolution after tre a tment was good in 66% of the cases, regular in 17%, bad in 12% and mortality was 5%. Conclusion: The factors that presented association with bad evolution or death were: year of publication between 1981 and 1989 and age group between 0 to 10 and 61 to 80 years. No diff e rence re g a rding tre a t m e n t type and evolution of these cases was found, since its distribution did not show a statistic significance (p=0,351). KEY WORDS: c e rebellum, cavernous malform a t i o n s , cavernomas and systematic review. * C a v e rnomas de cerebelo: revisão sistemática da literatura.