An analysis of the natural history of cavernous angiomas

TLDR

MR imaging has enabled early detection of cavernous angiomas before complications, yet surgical removal, though technically straightforward, requires careful weighing of risks and benefits. The study aimed to delineate the natural history of cavernous angiomas by reviewing all radiographically identified cases at a single institution. Researchers retrospectively examined 8,131 craniospinal MR scans from 1986–1989, identified 32 patients with 76 lesions, and reviewed their medical records to assess complication frequency. Among 32 patients (mean age 37.6 y), 50 % had seizures, 22 % focal deficits, 9 % hemorrhage, with hemorrhage risk 0.25 %/person‑year and seizure risk 1.51 %/person‑year; surgical intervention improved seizure control or deficits in eight cases.

Abstract

✓ The advent of magnetic resonance (MR) imaging has permitted the recognition of many angiographically occult vascular malformations before the development of complications and subsequent surgical removal. This study reviews all patients at one institution who had radiographically identifiable vascular malformations believed to represent cavernous angiomas in order to obtain information on the natural history of this particular lesion. All 8131 craniospinal MR images performed at our medical center from January 1, 1986, to November 30, 1989, were reviewed, and 32 patients were identified with 76 lesions meeting the MR imaging criteria for cavernous angioma. Medical histories, physical examination records, and other data from these patients were then reviewed to determine the frequency of complications. Their mean age at latest follow-up examination (or at surgical removal of the lesion) was 37.6 years (range 16 to 72 years). Sixteen patients (50%) had a history of seizures, seven (22%) had focal neurological deficits, and three (9%) had clinically significant hemorrhage attributable to the cavernous angioma; six patients (19%) were asymptomatic. The estimated risk of hemorrhage for this population is 0.25%/person-year of exposure; the estimated risk of seizure development is 1.51%/person-year. Eight patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit. Although these lesions are often excised with relative ease and minimal morbidity, the potential risks and benefits of surgery must be weighed carefully before removal of these relatively benign malformations.