Cavernomas brain-stem

Fig. 2.4a-c. CT (a) and sagittal Tl-weighted magnetic resonance (MR) (b) scan of another brain-stem cavernoma. Due to its calcification, it is easy to see even on the CT scan. The MR nicely reveals the typical cavernoma pattern with the dark rim of hemosiderin. Note that the acute hemorrhage occurred at the dorsal aspect of the cavernoma and now facilitates easy surgical removal. A view through the microscope while removing the cavernoma (c). Note the typical mulberry aspect of the malformation... 

If MRl is performed as a presurgical planning procedure, it is of utmost importance to scan with thin slices in order to demonstrate the relationship of the cavernoma to the surface of the brain. Particularly in brain stem cavernomas, this relationship is crucial for balancing the risk of the disease against the risk of surgical removal. 

Fig. 2.1 5a,b. On gradient echo sequence at 1.5 T (a) the brain stem cavernoma is hardly visible (arrow) but very obvious using high field MRI at 7 T (b). At 7 T additional vessels curving through the brain stem are detected... 

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