From the Guidelines
Cavernous hemangiomas are circumscribed vascular lesions with thin-walled sinusoidal spaces lined with endothelial tissue and containing intravascular or intervascular calcifications without intervening parenchymal tissue, as described in the study by 1.
Definition and Characteristics
These lesions can occur throughout the brain and even the spinal cord, and are characterized by the absence of arteriovenous shunting, which tends to result in less dramatic bleeding compared to other vascular malformations 1.
- They are often associated with seizures, focal neurological deficits, or isolated headaches, and can be asymptomatic in many individuals.
- The risk of hemorrhage is a significant concern, particularly for deeper lesions, with an estimated annual risk of 4.5% 1.
Diagnosis and Monitoring
Diagnosis is typically made using MRI with T2-weighted gradient-echo sequences, which can reliably identify cavernous malformations, even those that may not be apparent on other imaging modalities 1.
- Regular monitoring is essential for asymptomatic lesions, as they can increase in size over time and may eventually require treatment.
Treatment Options
Treatment depends on the location, size, and symptoms of the lesion, and may include surgical resection, stereotactic radiosurgery, or observation with regular monitoring 1.
- For symptomatic lesions, particularly those that have bled or cause persistent seizures, surgical removal is often recommended, as it can significantly improve outcomes and reduce the risk of further complications 1.
From the Research
Definition and Characteristics
- A cavernous hemangioma, also known as a cavernoma, is a benign vascular malformation that can be found in any region of the central nervous system 2, 3.
- It consists of well-circumscribed collections of thin-walled sinusoidal vascular channels lacking intervening brain tissue 2.
- Cavernous hemangiomas are present in 0.4-0.8% of the population and can occur in a sporadic or familial form 2.
Symptoms and Diagnosis
- The most common symptoms of cavernous hemangiomas are seizures, hemorrhage, and focal neurological deficits 2.
- Epilepsy is the most frequent manifestation of this malformation, and magnetic resonance imaging (MRI) is a sensitive and specific method for detection 3.
- High-resolution MRI is a useful diagnostic tool with a high degree of sensitivity and specificity 2.
- Other diagnostic methods, such as Tc-99m labeled red blood cells (RBC) scintigraphy, can be used to clarify the diagnosis between meningioma and hemangioma 4.
Treatment Options
- Microsurgical excision of the lesion is a good treatment choice for cavernous angiomas in the brain, even in the brainstem 2.
- Stereotactic radiosurgery may reduce the incidence of rebleeding and the frequency of seizures, but its indication should be carefully investigated due to the relatively high rate of radiation-induced side effects 2.
- Hypofractionated stereotactic radiosurgery (H-SRS) has been shown to be an effective and safe modality for treating giant cavernous sinus hemangiomas 5.
- Surgical resection is recommended for symptomatic cavernous angiomas in the orbit, but the rate of complications after resection is not necessarily low for cavernous angiomas within the apex 2.
Location and Clinical Features
- Cavernous hemangiomas can be located in various regions, including the brain, brainstem, cavernous sinus, orbit, and cranial nerves 2, 4, 6.
- The clinical features of cavernous hemangiomas can vary depending on their location, and may include symptoms such as diplopia, hearing loss, and vestibular disturbances 4, 6.
- The annual bleeding rate of patients with cavernous hemangiomas is reported to be 0.25%-20% 2.