Cavernous angioma
The cavernous angioma, cavernoma, it's a lesion consisting of blood vessels of various sizes, filled with blood and characterized by thin walls. It can be found in various areas of the nervous system: brain tissue, spinal cord, meninges (especially in the dura mater layer), brainstem, cranial nerves.
How widespread is cavernous angioma and how common is it?
This type of malformation is actually rather widespreadIt is estimated that it is present in 1 in 100/200 people, so much so that it constitutes approximately 8-15% of all intracranial and spinal vascular anomalies. Among the risk factors for the formation of a cavernous angioma, it is worth considering: familiarityIf a parent has developed familial (hereditary) cavernous angioma, their children have a 50% chance of suffering from the same condition.
Cavernous angioma: diagnosis
Cavernous angioma it is not visible during angiography And for a very specific reason: blood flows more slowly within the vessels. This particular type of blood circulation is most likely the reason why the symptoms are milder than those of other lesions. To reach a certain diagnosis, the best tool is magnetic resonance with and without contrast and with sequences gradient echoAccording to the data, the diagnosis occurs at a young age:
- 25-30% of diagnoses in patients aged 20 years or younger
- 60% in patients between 20 and 40 years old
- 10-15% in patients aged 40 or older
Symptoms of cerebral cavernous angioma
In fact, approximately 30% of subjects with cavernous angioma begin to perceive symptoms, especially between the ages of 20 and 30. It should be emphasized that in some cases the angioma it can be completely asymptomaticIf this is not the case, it is related to its location, since the surrounding structure tends to resist. The neurological deficits themselves are linked to the precise area where the cavernous angioma is located. Among the most common symptoms of cavernoma there are:
- headache
- Seizures
- weakness of the upper or lower limbs
- vision disorders
- balance problems
- memory and attention disorders
Symptoms may appear or disappear, depending on the changes in the malformation: it may increase or decrease in size. Bleeding and the resulting absorption also influence symptoms.
Treatment of cavernous angioma
When you are faced with a asymptomatic cavernous angioma, detected only during examinations with other objectives, it would be good to keep it monitored with magnetic resonance imaging at least once a year for two years and then once every five years. Observation is necessary, but not stringent: this is because, given the reduced blood flow, the risk of haemorrhage is not high, as is the case withbrain aneurysmThe patient may then be advised to take medication. anticonvulsants.
In the case of symptomatic cavernous angioma, it is necessary to evaluate whether the symptoms cannot be managed with pharmacological therapy, whether the malformation is located in an accessible area or not, and whether it is the main cause of the seizures. Once all these possibilities have been examined, it is possible to opt for a surgical intervention to remove the lesion.
A peculiar case: cavernous angioma of the brainstem
This type of cavernoma is characterised by a very particular location: it is found in a area absolutely essential for brain functionA possible hemorrhage could cause very serious neurological damage and in some cases death. Symptoms are also variable and appear in approximately 40% of subjects during the first bleeding. The patient may experience the classic headache, but also vomiting, dizziness, sensory alterationsMore rarely, they may occur trigeminal neuralgia, loss of consciousness, and cardiorespiratory failure. Like similar lesions, a brainstem cavernous angioma hemorrhage can cause neurological deficits depending on its location. These deficits tend to improve over time: 37% of patients recover completely. Surgery with complete excision it can be considered a useful tool especially with the aim of prevent a second hemorrhage after the first episode. Prompt intervention is necessary when the malformation significantly compresses the surrounding structures, which is the cause of the alteration of consciousness. In this situation, it is essential to active collaboration between neurosurgeon and neurophysiologist, which allows constant monitoring of neurological functions during surgery.
