What Is a Cavernous Malformation?

Cavernous hemangioma refers to a cavernous abnormal blood vessel cluster composed of many thin-walled blood vessels. Since abnormal blood vessel clusters are often not found during angiographic examination, it is classified as an occult vascular malformation. The disease is not really a tumor, but a vascular malformation that lacks arterial components. With the development of medical imaging, reports on the disease are increasing. The incidence in the population is estimated to be 0.5% to 0.7%, accounting for 8% to 15% of all cerebrovascular malformations. Because some patients are asymptomatic, the exact population incidence is still unknown. Cavernous hemangioma occurs in 30 to 40 years of age without significant gender differences.

Basic Information

nickname

Venous malformation

English name

cavernous hemangioma

Visiting department

Vascular surgery, neurosurgery

Multiple groups

20-50 years old

Common causes

Related to genetics, endocrine, environmental pollution, trauma and other factors

Common symptoms

Epilepsy, intracranial hemorrhage, neurological dysfunction and headache, etc.

Causes of cavernous hemangioma

Congenital doctrine

Infant patients and family history support the hypothesis of congenital origin. In recent years, studies have shown that cavernous hemangioma is an incompletely dominant autosomal dominant inherited disease, and the gene is located on q11q22 of the long arm of chromosome 7q.

2. Acquired Doctrine

It is believed that cavernous hemangioma can be induced by conventional radiotherapy, viral infection, trauma, surgery, and vascular response after bleeding.

Clinical manifestations of cavernous hemangioma

The main clinical manifestations of cavernous hemangioma were epilepsy (35.8%), intracranial hemorrhage (25.4%), neurological dysfunction (20.2%), and headache (6.4%). Asymptomatic patients accounted for 12.1%, and some patients had more than one clinical manifestation. If the lesion has bleeding, it will cause corresponding clinical symptoms. Some cavernous hemangiomas gradually increase, producing a space effect that causes neurological dysfunction to gradually increase. The clinical course varies greatly, and it may have acute or chronic neurological dysfunction, and may appear in remission or progressive exacerbation.

Epilepsy

Epilepsy is the most common symptom of cavernous hemangioma, which is almost twice the cerebral arteriovenous malformation. So far, the incidence of refractory epilepsy is unclear, but statistics of major cases such as Casazza show that 40% of patients with supra-cave cavernous hemangioma have clinical manifestations of refractory epilepsy. Lesions are located in the temporal lobe, with calcification or severe hemosiderin deposits, and men have a higher incidence of epilepsy. It is generally believed that seizures are related to the compression or stimulation of surrounding brain tissue by a lesion or hemorrhage, or cerebral hyperplasia.

Intracranial hemorrhage

Almost all patients with cavernous hemangioma are associated with subclinical microbleeds. Because the blood supply vessels are small and the pressure is low, bleeding with obvious clinical symptoms is relatively small, accounting for 8% to 37%. Women, especially pregnant women, children, and patients with a previous history of bleeding have relatively high bleeding rates. Compared with cerebral arteriovenous malformations, this disease is mostly less severe and is rarely life-threatening unless it is located in an important functional area. Even after conservative treatment after bleeding, recovery is generally better.

3. Focal neurological symptoms

Symptoms depend on the location and volume of the lesion. Examination of MRI can reveal bleeding within or around the lesion. Due to the dense nucleus and conduction bundle in the brainstem, lesions located in these areas often have neurological dysfunction.

4. No clinical symptoms

It accounts for 11% to 44% of all cases. Mild headache may be the only complaint. This disease is often found as a result of a physical examination or imaging examination. About 40% of asymptomatic patients can develop symptomatic cavernous hemangioma after six months to two years.

Cavernous hemangioma

Cavernous hemangioma is composed of three components: vascular component, which is composed of sinusoidal space, contains slowly flowing blood. Connective tissue interval. The surrounding area is glia hyperplasia.

1.CT

CT generally appears as a well-defined circle or quasi-circle to slightly higher density shadows, which can be combined with speckled calcifications. Generally there is no edema around, and larger lesions may have mild edema. Cavernous hemangioma can show a relatively uniform high-density acute hemorrhage, mild edema around the focus, and 70% to 94% of the lesions can be mildly to moderately enhanced after the injection of contrast agent. The degree of enhancement and thrombosis in the focus Associated with calcification, typically exhibits uneven spot-like enhancement. With cystic lesions, circular enhancement is seen. By delaying the time of the CT scan, the contrast-enhanced density can be increased. The glial hyperplasia zone around the lesion is low density, and the perifocal edema is generally not obvious. If the lesion is small or of equal density, it can be missed.

2.MRI

MRI diagnosis of cavernous hemangioma has higher diagnostic specificity and sensitivity. Repeated small and repeated bleeding in the tumor nest and the presence of dilute and free methemoglobin in the fresh thrombus make it high signal in all sequences. There are strip-shaped long T1 and short T2 signal bands in the lesion to form an explosion. Rice flower or grid-like mixed signal cluster, the surrounding ring with low signal band (especially T2 image is obvious) as the typical MRI manifestations of intracranial hemangiomas.

3. Digital Subtraction Angiography (DSA)

Cavernous hemangioma is an occult vascular malformation that is difficult to detect even with digital subtraction technology.

Cavernous hemangioma treatment

Cavernous hemangioma is a benign disease. The pros and cons of a treatment should be carefully weighed against the potential dangers of the natural course of treatment before making a treatment decision before making a decision. Surgical resection is an option, and the following conditions may be suitable for Gamma Knife treatment: People with a history of bleeding or epilepsy; Persons with neurological deficit caused by a placeholder effect; Patients who are not suitable for resection surgery; Rejected surgery Gamma Knife Healer.