1. Carvernous Hemangioma
Presented by Intern 許碩修

2. 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

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

4. 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

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

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

7. 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

8. MRI

9. MRI

10. 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

11. CT

12. 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

13. References
UpToDate
Radiology Review Manual
Emedicine

14. Thanks for Your Attentions!