Malformations cavernomas

In the presence of an intraspinal hemorrhage spinal vascular malformation, cavernoma, coagulopathy and tumor have to be differentiated. 

Pontine hemorrhages are fatal in around 50% of patients (Wijdicks and St. Louis 1997). Those caused by cavernomas or arteriovenous malformations have a better outcome (Rabinstein et at 2004). The management of patients with hypertensive pontine hemorrhage is usually conservative, but some case reports have documented successful stereotactic aspiration. However, there is likely publication bias and the natural history of the condition is difficult to predict since patients with small hemorrhages do well with conservative management. 

In conclusion, patients with head and neck venous malformations obviously have an increased probability of having a DVA and an increased chance of having multiple DVAs. There are no data on whether the risk of having cavernomas is also increased in this patient subgroup. 

Cavernomas, also called cerebral cavernous malformations or cavernous hemangiomas, are characterized by endothelium lined, sinusoidal blood cavities without other features of normal blood vessels like muscular or adventitial layers (Fig. 2.1) (McCormick et al. 1968). 

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... 

Fig. 2.6a,b. T2-weighted images of a patient who presented with recurrent attacks of severe headache. The referring clinician thought the patient had suffered from a subarachnoid hemorrhage. Magnetic resonance imaging revealed two mirror-like cavernomas, both located at the surface of the brain. The headache attacks were probably caused by repetitive microbleeds into the subarachnoid space and stopped after removal of the malformations... 

Hereditary hemorrhagic telangiectasia (Rendu-Osler disease) is not associated with cerebral capillary telangiectasia, but with other forms of cerebral vascular malformations (Maher et al. 2001), mainly true pial arteriovenous malformations, dural arteriovenous malformations, and, rarely, cavernomas. 

A dark lesion on GRE images, which is not visible on conventional T2, is usually not a cavernoma but a capillary malformation. Edema, gliosis, or signs of previous hemorrhage are usually absent. Follow-up images have never revealed any change in capillary malformations. 

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