Carvernous Hemangioma Presented by Intern 許碩修

Introduction Also noted as cavernous angioma, cavernoma, cavernous malformation 15% of vascular malformations Evolutionary nature Composd of dilated, thin-walled capillaries with a thin, fibrous adventitia No intervening neural tissue

Anatomy Cerebrum (70-90%) Posterior fossa (25%) subcortical, in rolandic and temporal areas Posterior fossa (25%) pons and cerebellar hemispheres

Epidemiology Sporadic or familial Equal in men and women Three genes have been reported in the familial type Equal in men and women Women commonly with hemorrhage and neurologic deficits Mean age of 30 to 40

Clinical Symptoms & Signs Supratentorial: hemorrhage, seizures and progressive neurologic deficits Annual bleeding rate: 0.25-1.1% Mass effect and secondary compromise of the microcirculation, local hemosiderin deposition

Clinical Symptoms & Signs Infratentorial: hemorrhage and progressive neurologic deficits Cranial neuropathies and long tract signs Annual bleeding rate: 2-3%, recurrent rate: 17-21%

Image Findings MRI: important for diagnosis Well-defined area of mixed signal intensity centrally (mulberry or popcorn) Hypointense rim on T2WI: hemosiderin (previous hemorrhage) Minimal mass effect or edema May associate with venous malformations, so contrast medium is needed

MRI

MRI

Image Findings CT Angiography Hyperdense with variable calcification Minimal or intense enhancement Angiography Minimal blood flow, occult vascular malformation 10% with capillary blush or early draining vein

CT

Treatment Asymptomatic: observation Surgical resection for accessible lesions progressive neurologic deficit, intractable epilepsy, and recurrent hemorrhage One series revealed good outcome in 97% of patients Inaccessible lesions: observation or stereotactic radiosurgery

References UpToDate Radiology Review Manual Emedicine

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