Brain cavernoma: Compare Costs for a treatment abroad

Cavernoma of brain is a cerebral vascular neoplasm that forms as a benign tumor in the brain. Cavernoma may be detected at any age in the form of a random finding in the brain. Cavernoma is mostly caused by some kind of neurological disorder. Sometimes it does not manifest itself during the lifetime, so the question of its removal must be approached carefully, because many patients can still lead the normal lifestyle without the surgery. There are both single and multiple malformations.

Brain cavernoma is mainly localized in the innate area of ​​the brain, most of all - in the hemisphere. The incidence of the disease - 0.6 cases per 100 000. The size of the formation can be very different - from a few millimeters to several centimeters. The most common size is about 3 centimeters.

Serious complication of cavernoma is bleeding of the brain, which can even result in death. According to recent findings risk of the brain bleeding varies from 0.25% to 16.5% annually. The probability of hemorrhage is increased for the patients, whose tumor affected the brain stem or deep parts of the brain. For patients who have already experienced  hemorrhage the chances of recurrent internal bleeding is 33.9%.

The main method of diagnosis is magnetic resonance imaging. Cavernoma may be an accidental "discovery" during the instrumental study conducted for other indications. Common types of this brain dysfunction is cavernoma of brainstem and spinal cavernoma.

Cavernoma of the brainstem

The cavernoma located in the brain stem is the most dangerous dangerous of vascular formation. It develops in a relatively small size of the anatomical brain region, so even minor bruises caused by bleeding may be accompanied by severe and focal cerebral damage. Specific neurological symptoms of this localization are dysfunctions of the cranial nerves are dizziness, impaired movements of the eyeballs, peripheral facial nerve paresis and bulbar or pseudobulbar disorders. In addition to the focal symptoms the patient may develop symptoms of hypertensiion in the midbrain.

Spinal cavernoma

Cavernous malformations of the spinal cord are much rarer, but its recurrent bleeding may lead to a progressive sensory, motor or autonomic function disorders. Often there is a dysfuntion of the pelvic organs. Lack of timely diagnosis and treatment can lead to irreversible changes and severe disability. Nerve cells may be damaged irreversibly.

A significant number of patients, particularly those with a long treatment history, experience the disorder of senses when they lose the ability to smell and touch things. The main complaint of patients is central radicular pain.

Symptoms of brain cavernoma

Typical signs of the disease are the seizures of epilepsy and severe headaches. Epilepsy cavernomas of brain are manifested in the form of frequent seizures resistant to medication. The parient may also experience nausea and emotional instability. If cavernoma is asymptomatic, it can result in seizure without any forwarning..

Diagnosis

The resonance imaging can detect both spainal and brainstem cavernomas. The resonance imaging gives 100% picture of the brain with  95% specificity of its all sectors. Another diagnosis is functional MRI. However, the use of this method is limited as picture presents information only about the surrounding tissues of the affacted area.

Treatment of brain cavernoma

Surgical removal of cavernomas is effective and it can be applied in case of multiple hemorrhages of the cavities located in the deeper areas of the brain. Brain cavernoma may be harmless, but sometimes surgery is conducted as a precaution. Operation relieves the patient of all possible risks, fraught with the disease.  After surgery the chances of epilepsy attacks decrease and, above all, the patient gets the immediate protection against subsequent hemorrhage. However, the operation can cause serious neurological disorders. Surgical intervention is determined by the location and condition of the patient`s neoplastic brain formation. Surgery is recommended in such cases:

  1. cavernoma is located on the surface of the brain and results in hemorrhage and seizures of epilepsy;
  2. cavernomas are located in functionally important areas, cortical, such as cerebral hemispheres
  3. persistent neurological disorders plan
  4. severe epilepsy syndrome.

Removal of cortical and subcortical cavernomas usually is not difficult. The most domplicated location is the spinal and brainstem cavernoma. During the surgery of the cortical and subcortical cavernomas the surgeons usually achieve the complete excision of the malformation and, as a consequence, the lack of repeated hemorrhages, as well as the termination of the further incidence. The severity of epileptic seizures also gradually decreases in the absence of deterioration in neurological function.  The sign of complete excision of the cavernoma is the cessation of bleeding. Getting rid of the attacks is one of the major challenges in the treatment of patients with cavernous malformations. The choice of surgical approach is based on a thorough study of the topography and MRI. Removing of the hematoma and malformation is made from its closest point to the brainstem.

The final decision about the surgery is made by the patient. Therefore, the patient must be fully informed about the methods of treatment, severity of his disease and all the possible outcomes of the surgery. If cavernoma is diifficult to access, the main method of treatment may be radiosurgery, but this method has serious side effects and possible complications.

The microsurgical removal of cavernoma is a common practice among neurosurgeons. However, radiosurgery is a direct alternative to this method if the location of cavernoma is in inaccessible areas of the brain, such as the brain stem. However, the impact of radiation energy causes inside changes in the brain similar to changes occurring after irradiation session.

Radiosurgical treatment of cavernoma  is aimed primarily at reducing the risk of recurrent bleeding and epilepsy attacks. Today, medical literature describes 450 cases of patients with cavernomas, who underwent such treatment option as "gamma knife" .After the use of “gamma knife" the annual risk of hemorrhage reduces by 80% after the first two years. Subsequently, the annual risk is reduced by 1,1-3,3%. There are several factors that could potentially increase the re-bleeding at the cavernous hemangiomas: first of all, if the cavernoma  is localized in the brain stem, as well as family history.

Approximately 54-74% of patients fully recover after treatment. It was noted that the best chance of a favorable outcome have the patients with a cavernoma, which appeared not later  than 6 months ago. There is an assumption that epilepsy can appear after the cavernoma.

Angioma of the brain

Angioma is a vascular neoplasia, located in the lymph vessels. Hemangioma and cavernoma are actually synonyms / subspecies of the angioma with the difference that hemangioma and cavernoma are filled inside with blood. Most of the angioma formations develop among children, including newborns, as a congenital malformation. Angioma is very often considered an intermediate disease between a tumor and simple malformation.

Venous angioma of the right brain frontal lobe is a disease that can be treated only in the international clinics.

Most often, such diseases as cerebral venous angioma are located in different parts of the brain.

Cavernous angiomas of the brain may be caused by any infectious disease.

The main brain angioma symptoms is the headache in the right frontal lobe. Similiar to cavernomas, brain angioma may be accompanied by convulsions and seizures resembling epileptic attacks. Frequent nausea and vomiting, paralysis of certain body parts are also brain angioma symptoms. Dizziness and noise can even appear in the brain. Some patients report a violation of speech, sight, taste.

Brain angioma can appear in any area of ​​the brain. Sometimes the disease is able to attack even the spinal cord. There may be a severe back pain that will hinder the movement of the patient. The blood supply throughout the body can also be slowed by the paralysis of some parts of the body. Sometimes the brain angioma may develop in the brain stem and cerebellum and in that case it may transform into cavernoma, if it accumulates blood in the vascular formation.

Angioma in brain may lead to the most diverse effects that depend on the severity of the disease. The increase in the ​​vascular congestion may occur as a consequence of hemorrhage.

The brain angioma has three types. The first type is cavernous angioma, which is characterized by an accumulation of small blood vessels and blood flow disorder. Cerebral venous angioma involves dilatation. Capillary angioma is a cluster of capillaries that slow the outflow of blood. Interestingly, in this case the cluster of capillaries is only a few millimeters.

Sometimes, when a person has no angioma symptoms, and the disease generally does not bother him, the treatment can be postponed for a while. If the vessels are located on the surface of the brain, they can be easily removed using surgery without touching the cord at all. All healthy brain tissue will also be preserved. If the vessels are too deep, then the doctor may need special catheter, which is inserted deeply into the brain. This special catheter may help clog vessels. In some cases, the radiation emission also eliminates the cavernous angioma brain tumor. Radioactive beam is directed at the accumulated small blood vessels. Thus, they are reduced in size and after some time they completely disappear.

Depending on the lacation angioma may bring absolutely different health disorders.

Vascular angioma tumors of the frontal lobe can trigger changes in the mentality and behavior and even compression of the optic nerves.

Angioma of  the cerebellum is accompanied by the loss of movement coordination. Patients are unable to perform purposeful actions. Adjacent brain stem is one of the most dangerous and inaccessible location of the tumor. Damage to the vital nerve centers of this region (vaso-motor, breathing) can cause cardiac arrest and breathing.

Vascular tumors of the parietal lobe provoke convulsions, impaired hearing, thinking, loss of ability to understand and reproduce the information. The patient also does not feel pain, the temperature of objects, touch.

 

In case the tumor is small, it does not increase in size, does not bother the patient and the risk of rupture is minimal, the doctor may suggest a dynamic observation. Typically, such observation is practiced if angioma is located on the surface of the brain. For children these tumors may regress completely within 3-4, so it makes sense to wait for angioma`s disappearance, because removal can be traumatic and leave a scar.

Brain hemangioma

Brain hemangioma is another subtype of angioma and cavernoma, when "vascular tumors" or malformations can appear in various organs, mostly in the brain. Hemangiomas are tightly intertwined tangles of blood vessels filled with blood. Often between the vessels there is a brain tissue and this tissue is the difference between cavernoma and hemangioma. Hemangiomas can sometimes be seen on the skin of children at an early age. They look like small bright red spots or blisters. Brain hemangioma look exactly like that.

As the malformation in the brain may be in absolutely any department of the brain, then their late symptoms are most commonly associated with the work of the department in which they are located. For example, if hemangioma is located in the frontal lobes of the cerebral hemispheres, it may adversely affect the optic nerve leading to loss of vision.

If the malformation is located in the cerebellum, it can lead to disturbances in motor coordination, unsteady gait, disruption of motor skills of hands, and so on. When the location of hemangioma is very deep the patient may experience aching pain in the head, "rumble" in the ears and so on.

It has already been pointed out that often hemangiomas and other malformations for a long time have no clear symptomatic manifestations. Because of this it is rather difficult to diagnose them without the special quipment.

The most accurate method of determining the presence of hemangiomas is a contrast angiography (vascular research). During the angiography the patient is given a special radiopaque medication (intravenously) and then the doctor makes an X-ray examination of the head. Despite the effectiveness of this method, the angiography is not secure enough, that`s why it is not used very often.

To replace the angiography the doctors invented another method, called the superselective angiography. During the superselective angiography this method the catheter is injected specifically in the area where the hemangioma or other malformations are most likely to be located.

However, superselective angiography and simple angiography are invasive methods and such foreign substances as punctures, cuts always have a negative effect on the brain.The head area is very vulnerable and susceptible to any intervention, so these methods are not perfect. It is best to diagnose brain malformations through the non invasive method (without violating the integrity of skin and other tissues and also without introducing foreign substances).

Types of hemangiomas are divided into torpid (sluggish developmed) and hemorrhagic (are prone to bleed). Hemorrhagic type is a small vascular tangle in the brain. The main symptom is hypertension - increase in blood pressure.

Torpid type is large tangle of arteries in the brain. Such hemangiomas manifest themselves in the form seizures, cluster headaches (pain in one particular part of the head), sleep disorders and neurological disorders.

Convulsions during the torpid hemangiomas can happen at the same time in multiple places or locally in only one place. They are accompanied by a sharp pain in the head (and often pain center coincides with the location of the hemangioma), and sometimes by even loss of consciousness, This set of symptoms can often be confused with the malignant brain tumor.

Also men experience these symptoms more frequently than women. For females these symptoms are manifested only during pregnancy.

Hemangiomas, cavernomas, angiomas and other vascular malformations are much more serious diseases than it may seem at first. Even if they do not show themsleves - when the doctor detects hemangioma during the examination the person should think about its serious treatment, because, if is diagnosed earlier, albeit the small size, it may be cured.

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