About the disease
Cavernoma of the brain is a benign vascular neoplasm. It is mostly caused by genetic factors. Brain cavernoma is most often located in the brainstem and thalamus, less often – in the cerebellum and the 4th ventricle. Cavernomas may be solid or multiple (up to 3-5 closely spaced cavities). The size of formation can be very different, from few millimeters to several centimeters. Incidence of the disease is 0.6 cases per 100 000 population.
The most dangerous complication of cavernoma is bleeding in brain, which can even lead to death. According to recent findings, risk of the brain bleeding varies from 0.25% to 16.5%. Probability of hemorrhage is increased in patients with cavernomas in the brain stem. For patients who have already experienced hemorrhage the chance of recurrent internal bleeding reaches 33.9%.
Symptoms
- Seizures similar to epilepsy
- Severe headaches
- Nausea
- Emotional instability
Diagnosis
- X-ray. This is not a first-line diagnostic technique, but it can reveal big cavernomas. It may be an accidentally revealed during the examination due to other condition.
- Angiography shows exact size and structure of the cavernoma. Contrast agent is injected into a patient’s vein, so brain vessels become perfectly visible in the radiograph.
- MRI is the main method of diagnosis. It is best in detecting both spinal and brainstem cavernomas. Resonance imaging gives picture of the brain and allows doctor to estimate state of vascular formation and surrounding tissues.
Treatment
- Surgical removal is effective in most cases and can be applied in patients with multiple cavernomas. Surgery eliminates all possible risks, connected with this disease. After surgery chances of epilepsy attacks decrease and patient gets protection against subsequent hemorrhage. Surgical intervention is planned according to the location and condition of cavernoma.
- Platinum coils embolization (coiling) is often applied for treatment of malformations in the brain. This method uses technology of inserting platinum coil into the brain to reduce volume of the cavernoma and prevent bleeding.
- Partial resection and coiling is also an effective treatment option, which which combines the advantages of both techniques.
- If cavernoma is located deeply, main method of treatment is radiosurgery. Radiosurgical treatment is aimed at reducing the risk of recurrent bleeding and epilepsy attacks. The best results are seen if the size of cavernoma doesn’t exceed 1 cm. Radiosurgical treatment is performed with the help of Gamma-knife. This is the device that directs irradiation precisely at the cavernoma. Gamma-knife doesn’t require opening the skull or even staying in the hospital. After such treatment risk of hemorrhage is reduced by 80%.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
