Surgical Management of Brain Cavernomas in Children

Abstract

Background: Cavernous hemangiomas are benign vascular hamartomas caused by developmental malformations of the vascular bed. They can be found in 0.3–0.7% of the population, whereas one fourth of these lesions occur in children. Methods: In the present study, we report on 16 cases of cavernomas surgically treated in our institute. From each patient’s file, the age, sex, lesion location, symptoms and follow-up were analyzed. Results: The most commonly presenting symptom was epilepsy. Radiological signs of acute hemorrhage were observed in 3 cases. Three children had multiple cavernomas. The parietal lobe was the most common site of occurrence, whereas only 2 cavernomas were infratentorial. There was no operative mortality. Postoperatively, there was no additional neurological deficit, and all patients gradually improved. In a case of pontine cavernoma, there was a need for reoperation due to rebleeding. Conclusion: With the improvement of microsurgical techniques and modern neuroimaging, nearly all cavernomas can be safely removed. Total resection is associated with patients’ clinical improvement and seizure control.

Resection of supratentorial lobar cavernous malformations in children

“…Extracting patient data from previous reports (9 series with 189 patients) demonstrates consistent, exceedingly high complete resection rates for these lesions (99% overall) ( Table 3). 2,5,10,12,13,15,19,27 Improved intraoperative navigation, intraoperative ultrasound, and now intraoperative MRI are key components to achieving this statistic. Our 2 cases of incomplete resection represent exceptional cases-one with a lesion entirely embedded in motor cortex without a safe corridor of access ( Fig.…”

“…2,5,12 Of particular note is the marked increased risk for complications (not unexpectedly) for lesions in eloquent cortex. Only 2 patients (1%) across all reviewed series had worsening seizures after treatment, while 94% of patients were seizure free at follow-up.…”

Clinical features and microsurgical treatment of pediatric patients with cerebral cavernous malformation

“…1,2 The incidence of pediatric CCM is estimated to be 0.37% to 0.53%, which represents 25% of all CCM. 3 Because children possess unique physiological features during development, the surgical management of pediatric CCM patients differs from that of adult patients with CCM.…”

Treatment of pediatric patients with cerebral cavernous malformation

“…Postoperatively patients' improved clinically and seizures were controlled in most patients, thereby justifying surgery as the treatment of choice. 2 However, recent studies on the treatment of haemangioma of infancy revealed that propranolol may be an effective treatment modality. 3 Based on that information we administered propranolol to a patient with a giant cerebral cavernous malformation and the lesion demonstrated a significant volume shrinkage.…”