Cavernous angiomas belong to a group of intracranial vascular malformations that are developmental malformations of the vascular bed. These congenital abnormal vascular connections frequently enlarge over time. The lesions can occur on a familial basis. Patients may be asymptomatic, although they often present with headaches, seizures, or small parenchymal hemorrhages.
The sensitivity of MRI to flowing blood and blood products of varying ages, as well as the greater contrast resolution of MRIs, greatly increases the specificity of MRI compared with that of CT. Combining multiple MRI sequences has largely eliminated misdiagnosis of cavernous angiomas, because they have relatively specific signal characteristics. Additionally, gradient-echo imaging, with its increased sensitivity to susceptibility artifact, is useful in the detection of smaller and concomitant lesions, which may not be detected with traditional sequences.
Most cavernous malformations do not produce significant symptoms in patients, and most can simply be followed up over time. For patients in whom lesions cause significant neurologic morbidity, treatment options are available. These options differ depending on the location, size, and amount of the associated hemorrhage. Surgical resection is an option, but depending on the location of the lesion and the patient's existing comorbidities, surgical resection is not the best option in some cases. Stereotactic radiosurgery is an important option in AVMs and hemorrhagic cavernous malformations. The procedure is relatively contraindicated in patients with concomitant venous angiomas because of the high incidence of posttreatment morbidity.
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