Rare asymptomatic giant cerebral cavernous malformation in adults: two case reports and a literature review

Abstract

Cavernous malformations are benign vascular malformations. Giant cavernous malformations are very rare. All reported cases have been symptomatic because of the large size and compression of the surrounding brain tissue. We report two asymptomatic cases of giant cavernous malformation that were both misdiagnosed as neoplasms because of their atypical presentations. The first case was a 54-year-old man whose computed tomography and magnetic resonance imaging scans revealed an inhomogeneous lesion of 6 cm diameter and mild enhancement in the left frontal lobe. A left lateral supraorbital and transcortical approach was applied and the lesion was completely removed. The second case was a 36-year-old man with an irregular large mass in the parasellar region. Craniopharyngioma was suspected and gross total resection was performed. Post-surgical pathological analyses confirmed the diagnoses as cavernous malformations. Both patients recovered uneventfully. The rare asymptomatic giant cavernous malformations reported here in adults had benign behavior for this specific disease entity. The different clinical characteristics of ordinary cavernous malformation and adult and pediatric giant cavernous malformation imply complex and distinct genetic backgrounds. Concerns should be raised when considering giant cavernous malformation as a differential diagnosis for atypical large lesions. Surgical resection is recommended as the primary treatment option.

Resection of Intracranial Giant Cavernous Malformation: Case Report and Literature Review

“…A study conducted by Wang et al at Beijing Tiantan Hospital and Capital Medical University found the incidence of GCMs among the entire series of central nervous system CMs to be 0.65% (9 of 1395 cases). All of them were surgically treated with gross total resection and had neurological status improved in 55.6% when assessed by mRS [6].…”

“…The sizes of CMs are highly variable, ranging from a few millimeters to several centimeters. However, unlike giant aneurysms, which have a definite threshold (diameter > 25 mm), there exists no consensus on when to call a CM ''giant" [4] [5] [6].…”