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Cavernoma of brain is a cerebral vascular neoplasm that forms as a benign tumor in the brain. Cavernoma is mostly caused by neurological disorders. 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 formation can be very different - from few millimeters to several centimeters. Most common size is about 3 centimeters.
The most dangerous complication of cavernoma is bleeding in brain, which can even result in death. According to recent findings risk of the brain bleeding varies from 0.25% to 16.5% annually. Probability of hemorrhage is increased for the patients, whose tumor affected brain stem. For patients who have already experienced hemorrhage the chances of recurrent internal bleeding estimate 33.9%.
Cavernoma of brainstem
Cavernoma located in the brainstem is the most dangerous vascular formation. It develops in a relatively small size and after that it damages brain tissues. It becomes very dangerous for patients to have any kind of injuries. Even minor bruises caused by bleeding can lead to severe and focal cerebral damage. Specific neurological symptoms of this localization are dysfunctions of cranial nerves, dizziness, impaired movements of eyeballs, peripheral facial nerve paresis and bulbar or pseudobulbar disorders. In addition to that patient may develop symptoms of hypertension in midbrain.
Cavernous malformations of spinal cord are much rarer, but its recurrent bleeding may lead to progressive sensory, motor or autonomic function disorders. Often there is a dysfunction of the pelvic organs. Lack of timely diagnosis and treatment can lead to irreversible changes and severe disability. A significant number of patients, particularly those with a long treatment history, experience the disorder of senses as they lose ability to smell and touch things.
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 are cavernoma of brainstem and spinal cavernoma. Approximately 54-74% of patients fully recover after treatment.
Magnetic resonance imaging is best in detecting both spinal and brainstem cavernomas. Resonance imaging gives 100% picture of the brain with 95% specificity of its all sectors. Another common diagnostic method is MRI. However, the use of this method is limited as picture presents information only about surrounding tissues of the affected area.
Surgical removal of cavernomas is in most cases effective and can be applied in case of multiple hemorrhages of the cavities located in the deeper areas of the brain. Surgery also relieves patient of all possible risks, connected with this disease. After surgery chances of epilepsy attacks decrease and patient gets protection against subsequent hemorrhage. Surgical intervention is determined by the location and condition of patient's neoplastic brain formation.
During the surgery doctor usually achieves complete resection of malformation. He also decreases significantly the number of epileptic-like seizures and restores neurological function. Sign of complete cavernoma excision is cessation of bleeding. Choice of surgical approach is based on a thorough study of topography and MRI. Removing and malformation is made from its closest tangential location to the brainstem
Platinum coils embolization (coiling) is often used for treatment of malformations in the brain. According to MayfieldClinic.com, which is a medical site, this method uses technology of inserting with catheter platinum wire into the brain to prevent bleeding.
Partial resection and coiling is also an effective treatment option, which is a microsurgical removal of cavernoma.
If cavernoma is difficult to access, main method of treatment is radiosurgery. 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 “gamma knife" treatment risk of hemorrhage is reduced by 80% after the first two years. Subsequently, annual risk reduces by 1,1-3,3%.
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