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Cavernomas of the central nervous system: Clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases

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Summary

We present our clinical experience and the results of surgical management with 25 cavernomas of the CNS, treated in our hospital in the last 10 years. The location of the lesion assessed by clinical and CT scan examinations, proved to be the most significative factor determining the prognosis of cavernomas of the CNS, after surgical removal.

The symptoms started in most of the cases in the third decade of life. 19 cases were located in the cerebral hemispheres and produced three well defined clinical syndromes:

  1. 1)

    Irritative syndrome (seizures) present in 70% of the cases.

  2. 2)

    Space-occupying lesion syndrome (20%) and

  3. 3)

    haemorrhagic syndrome (10%).

The remaining six cases were located within the basal ganglia, brainstem, pineal region, cerebellum and spinal cord, showing a progressive course.

CT scan studies were performed on 24 cases. The characteristic image of a cavernoma is represented by a moderately hyperdense nodule with discreet contrast uptake. Calcification was observed in and around the lesions in 33% of the cases. Perilesional hypodensities suggestive of brain tissue atrophy were noted in 22% of the CT scans. On the other hand, 12% of cerebral hemisphere cavernomas showed atypical CT scan images that suggested an erroneous diagnosis of cystic gliomas.

Radical surgical removal was performed in all cases. The postoperative results varied according to the location of the lesions. Complete recovery was obtained with cerebral hemisphere cavernomas presenting with a progressive history suggesting tumour or a haemorrhagic syndrome. 85% of the cases presenting with seizures, were symptom-free and taking no anticonvulsants 1 year after surgery. In deeply placed cavernomas (basal ganglia and brainstem) the surgical results were poor. In the latter cases surgery has to be carefully evaluated when a mode of treatment is to be considered in patients whose CT scan data strongly suggest a diagnosis of cavernoma.

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Author notes

  1. J. Vaquero

    Present address: Department of Neurosurgery, Puerta de Hierro Clinic, Autonomous University, Madrid, Spain

Authors and Affiliations

  1. Department of Neurosurgery, Puerta de Hierro Clinic, Autonomous University, Madrid, Spain

    J. Salazar, R. Martínez, P. Martínez & G. Bravo

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  1. J. Vaquero
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  2. J. Salazar
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  3. R. Martínez
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  4. P. Martínez
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  5. G. Bravo
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Vaquero, J., Salazar, J., Martínez, R. et al. Cavernomas of the central nervous system: Clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases. Acta neurochir 85, 29–33 (1987). https://doi.org/10.1007/BF01402366

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