Cavernoma

What is Cavernoma?

The clinical term “cavernoma” refers to a cluster of abnormal blood vessels that usually found in the brain and spinal cord. Cavernoma also known as cavernous angiomas, cavernous hemangiomas, or cerebral cavernous malformation (CCM). A typical cavernoma varies in size from few millimeters to several centimeters and looks like a small mulberry. Usually, cavernoma can exist without showing any obvious symptoms.

Symptoms occur when cavernoma causes internal hemorrhage in the brain and spinal cord. Recurrent episodes of bleeding lead to the development of seizures and vision issues in the patient. Other signs and symptoms of cavernoma include severe headache, nausea, vomiting, balance and speaking difficulties, sensitivity to light, problems with memory and vision, dizziness, and weakness or numbness in one side of the body. Symptoms of cavernoma may vary according to the location of the blood clot. Long-term cavernoma can be life-threatening and create long-lasting problems in your body. Complications of cavernoma may lead to progressive neurological damage and even in rare cases death.

Cavernoma typically develops with no apparent reason most times. Approximately one in 200 people suffer from this condition 1. About 25% of cavernoma cases occur due to genetic reasons. But most cases of cavernoma occurs randomly 2. Research reveals an association between cavernoma cases and radiation exposure in the child. Most of the cavernoma cases occur before 30 years of age.

How do Neurosurgeons Diagnose Cavernoma?

Cavernous malformation represents a congenital or acquired vascular anomaly that occurs in approximately 0.5% of the general population 3. The location of cavernoma varies in several positions of the brain, but mostly found in the supratentorial region. Angiography detects the existence of abnormal venous drainage associated with cavernoma and other imaging test provides an accurate diagnosis.

Early diagnosis of cavernoma seems difficult because people with this malformation doesn’t show any signs or symptoms. This malformation remains unnoticed until a hemorrhagic event occurs. Your doctor may perform brain imaging for other neurological conditions and then found cavernous malformations in your brain. Depending on the specific symptoms, your doctor will perform more extensive testing. These include 4:

  1. Magnetic resonance imaging (MRI): This test presents a detailed picture of your brain or spine. Your doctor may inject a contrast dye into the vein of your arm to observe the blood vessels in a different way. The different MRI techniques include Conventional T1- and T2-Weighted MR Imaging, Gradient Recalled Echo (GRE) MR Imaging, High-Field MRI, Diffusion Tensor (DT) Imaging, and Susceptibility-Weighted MR Imaging.
  2. Genetic testing: If you have a family history of this malformation, you should go for genetic testing. This test helps to identify the changes associated with cavernous malformations in the genes or chromosomes of a patient.

How do Neurosurgeons typically treat Cavernoma?

Treatment of cavernomas depends on the clinical presentation and factors such as size, location, and the number of lesions. The entire team requires an expert neurologist, a neurosurgeon, a neuroradiologist, and other specialties to treat cavernoma. Treatment protocol may include 5:

  1. Observation

For asymptomatic condition, if your doctor accidentally discovers cavernoma, he may initially decide to monitor your malformations. Doctors suggest to perform intermittent testing such as magnetic resonance imaging (MRI) to observe any changes in the malformation. If this increase, your doctor will take further decision.

  1. Medications

Patients showing typical symptoms of cavernoma such as headaches and seizures need to control with proper medication.

  1. Surgery

Your doctor will consider the surgical option if the previous option doesn’t work. Surgery will reduce the risk of future hemorrhages and acts as the only cure for cavernomas. Most preferable surgical techniques include neurosurgery and stereotactic radiosurgery.

During neurosurgery, doctors will perform general anesthesia to remove the cavernoma by making a small hole to expose the brain (craniotomy). In the case of radiosurgery, surgeons will use a single concentrated dose of radiation to prevent further growth of cavernoma. You should always discuss with your doctor about the possible risks of each treatment.

References

  1. Knerlich-lukoschus, F., Steinbok, P., Dunham, C. & Cochrane, D. D. characteristics. 16, 256–266 (2015).
  2. Cisneros, O., Rehmani, R. & Garcia de de Jesus, K. Cerebellar Cavernous Malformation (Cavernoma): A Case Report. Cureus 11, 3–7 (2019).
  3. Idiculla, P. S., Gurala, D., Philipose, J., Rajdev, K. & Patibandla, P. Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review. Eur. Neurol. 10305, (2020).
  4. Augenstein, J. A., Chapman, T., McNeil, M. J. & Lo, M. D. ‘it’s Not a Tumor’: A Rare Case of Symptomatic Cerebellar Developmental Venous Anomaly. Pediatr. Emerg. Care 35, E40–E41 (2019).
  5. Neetens, A. Traumatic (bi)temporal hemianopia. Neuro-Ophthalmology 12, 375–383 (1992).

 

 

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