Cavernoma and Other Malformations




(1)
Neurosurgery teaching hospital, Baghdad, Iraq

 



This book contains some difficult questions marked with “ * “ sign.





  1. 1.


    Cavernoma (cavernous malformation, cavernous hemangioma, or cavernous angioma)

    The FALSE answer is:


    1. A.


      A low-flow well-circumscribed, benign vascular hamartoma.

       

    2. B.


      Cavernomas consist of irregular thick- and thin-walled sinusoidal vascular channels located within the brain but no arteries.

       

    3. C.


      Cavernomas comprise 9 % of CNS vascular malformations.

       

    4. D.


      Cavernomas are mainly supratentorial.

       

    5. E.


      Cavernomas are the only vascular malformation with intervening neural parenchyma.

       

     





  • The answer is E.



    • The only vascular malformation without intervening neural parenchyma.


    • A low-flow well-circumscribed, benign vascular hamartoma consisting of irregular thick- and thinwalled sinusoidal channels located within the brain but no arteries.




  1. 2.


    Cavernomas

    Location, the FALSE answer is:


    1. A.


      Two-thirds are supratentorial.

       

    2. B.


      Common in the frontal or temporal lobes.

       

    3. C.


      4–35 % of cavernomas in the brainstem.

       

    4. D.


      5–10 % of cavernomas in the basal ganglia.

       

    5. E.


      Associated with developmental venous anomaly (DVA) that should be resected also.

       

     





  • The answer is E.



    • Associated with DVA (represents venous outflow and should be preserved).


    • 4–35 % of cavernomas in the brainstem (commonly in the pons).




  1. 3.


    Cavernoma

    Pathology, the FALSE answer is:


    1. A.


      Caverns are filled with blood in various stages of thrombus formation, organization, and dissolution and may calcify.

       

    2. B.


      Cavernoma’s gross appearance resembles a mulberry.

       

    3. C.


      Cavernoma is sometimes called “the hemorrhoid of the brain.”

       

    4. D.


      Cavernoma has abnormally hypertrophied smooth muscle layer.

       

    5. E.


      Two types: sporadic and hereditary (autosomal dominant).

       

     





  • The answer is D.



    • Smooth muscle layer is absent or minimum.


    • Light microscopy: stains for von Willebrand’s factor.


    • EM: shows abnormal gapping of the tight junctions between endothelial cells (may permit leakage of blood).




  1. 4.


    Cavernoma*

    Pathology, the FALSE answer is:


    1. A.


      Cystic variant of cavernoma occurs more commonly in the posterior fossa.

       

    2. B.


      Dural-based variant of cavernoma occurs more commonly in the parasellar area.

       

    3. C.


      Hemangioma calcificans variant of cavernoma occurs more in the temporal lobe.

       

    4. D.


      Cavernomas are very rarely multiple.

       

    5. E.


      Previous radiotherapy appears to be a risk factor.

       

     





  • The answer is D.



    • Cavernomas are multiple in less than 50 %.


    • Previous radiotherapy appears to be a risk factor especially for spinal cavernomas.




  1. 5.


    Cavernoma

    Presentation, the FALSE answer is:


    1. A.


      The most common presentation is seizures and progressive neurologic deficit.

       

    2. B.


      20 % of cavernomas presented with hemorrhage.

       

    3. C.


      Hemorrhage appears to be higher in females.

       

    4. D.


      Hemorrhage is always fatal.

       

    5. E.


      Cavernoma may rarely present with hydrocephalus or as in incidental finding.

       

     





  • The answer is D.



    • Hemorrhage risk is difficult to predict, but rarely fatal.


    • The common presentations are seizures (60 %), progressive neurologic deficit (50 %), hemorrhage (20 %) (usually intraparenchymal), hydrocephalus, or as in incidental finding.




  1. 6.


    Cavernoma

    Risk factors for hemorrhage, the FALSE answer is:


    1. A.


      The size of the cavernoma (>1 cm)

       

    2. B.


      Female gender and pregnancy

       

    3. C.


      Prior symptomatic bleed

       

    4. D.


      Age more than 35 years

       

    5. E.


      Deep location of the lesion

       

     





  • The answer is D.



    • Age less than 35 years is also a risk factor for hemorrhage.




  1. 7.


    Cavernoma

    Radiology, the FALSE answer is:


    1. A.


      CT scan is sensitive but not specific.

       

    2. B.


      Gradient-echo T2WI MRI is the most sensitive test.

       

    3. C.


      In MRI, the mixed signal core with low-signal rim described as “popcorn” pattern is pathognomonic.

       

    4. D.


      Angiography is highly sensitive for cavernomas.

       

    5. E.


      The diagnosis is strongly suggested by finding multiple lesions with a positive family history.

       

     





  • The answer is D.



    • Angiography for cavernomas is usually negative (usually angiographically occult).


    • CT scan is sensitive but not specific. May overlap with low-grade tumors, hemorrhages, and granulomas.


    • Diffusion tensor imaging/white matter tractography and preop 3D-constructive interference in steady-state (CISS) MRI may improve localization, approach, and post-op outcomes.




  1. 8.


    Cavernoma*

    Radiology, Zabramski classification, the FALSE answer is:


    1. A.


      Type I: subacute hemorrhage

       

    2. B.


      Type II: classic “popcorn ball” lesion

       

    3. C.


      Type III: chronic hemorrhage

       

    4. D.


      Type IV: multiple punctate micro-hemorrhages

       

    5. E.

Tags:
Jun 24, 2017 | Posted by in NEUROSURGERY | Comments Off on Cavernoma and Other Malformations

Full access? Get Clinical Tree
Get Clinical Tree app for offline access