Endoscopic Endonasal Excision of an Optic Pathway Cavernous Malformation: Technical Case Report

2021 ◽  
Author(s):  
Biren Khimji Patel ◽  
A Jaypalsinh Gohil ◽  
Prakash Nair ◽  
Easwer H.V. ◽  
Deepti A.N.
Keyword(s):  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Low Flow ◽  
Visual Field Defects ◽  
Optic Pathway ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations ◽  
Magnetic Resonance Imaging Mri ◽  
Bitemporal Hemianopia

Abstract BACKGROUND AND IMPORTANCE Cavernous malformations (CMs) are angiographically occult low-flow vascular malformations that infrequently involve the optic pathway and the hypothalamus (OPH). CLINICAL PRESENTATION A 23-yr-old male presented with bitemporal hemianopia due to chaismal apoplexy. Imaging revealed a CM involving the OPH. The CM was resected by an extended endonasal approach. The patient had improvement in his visual field defects, and postoperative magnetic resonance imaging (MRI) revealed a gross total resection of the CM. CONCLUSION This case demonstrates the surgical technique of endoscopic endonasal resection of a CM involving the optic pathway.

Transclival Approach for Resection of a Pontine Cavernous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E413-E413
Author(s):  
Dennis London ◽  
Seth Lieberman ◽  
Omar Tanweer ◽  
Donato Pacione
Keyword(s):  
Cavernous Malformation ◽  
Case Reports ◽  
Abducens Nerve ◽  
Petrous Bone ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations ◽  
Lumbar Drain ◽  
Magnetic Resonance Imaging Mri

Abstract Cerebral cavernous malformations are common vascular anomalies consisting of a cluster of capillaries without intervening brain tissue.1 A variety of approaches for resection have been undertaken,2 and a handful of case reports have described the endoscopic, endonasal, transclival approach.3 We present a case of a 51-yr-old woman with lupus and hepatitis B-associated cirrhosis who presented with diplopia, dysphagia, and ataxia. She had a left abducens nerve palsy and magnetic resonance imaging (MRI) showed a left pontine cavernous malformation. After a repeat hemorrhage, she consented to surgical resection. The lesion appeared to come to the medial pontine pial surface. Tractography indicated a rightward displacement of the left corticospinal tract. Therefore, an endoscopic, transnasal, transclival approach was chosen. A lumbar drain was placed preoperatively. The clivus and ventral petrous bone were drilled using the vidian canal to help identify the anterior genu of the petrous carotid artery. The clival dura was opened, revealing the abducens nerve exiting the ventral pons. The cavernoma was visible on the surface lateral to the nerve. It was removed using blunt dissection and the remaining cavity inspected. The skull base was reconstructed using an abdominal dermal-fat graft and Alloderm covered by a nasoseptal flap. Postoperatively she had transient swallowing difficulty. The lumbar drain was kept open for 5 d. Cerebrospinal fluid (CSF) leak was ruled out using an intrathecal fluorescein injection. She was discharged home, but presented 2 wk postoperatively with aseptic meningitis, which was treated supportively. Postoperative imaging did not show residual cavernoma.

scholarly journals Brainstem cavernous malformation

2013 ◽  
Vol 32 (01) ◽  
pp. 31-36
Author(s):  
Ariel Roberto Estramiana ◽  
Diana Lara Pinto de Santana ◽  
Eberval Gadelha Figueiredo ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Central Nervous System ◽  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Resonance Imaging ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Brainstem Cavernous Malformation

AbstractCavernous malformation (CM) of the central nervous system (CNS) are acquired or developmental vascular malformations that represent the 5% to 15% of all vascular malformations of the CNS. Eighty to ninety percent of CM are supratentorial, 15% infratentorial, and 5% occur in the spinal cord. The subset of brainstem malformation presents as a very difficult paradigm for treating clinicians. The widespread use of magnetic resonance imaging (MRI) has increased the recognition of this disease. Clinical presentation, pathophysiology and treatment are discussed in this article.

scholarly journals Transcriptome-wide Profiling of Cerebral Cavernous Malformations Patients Reveal Important Long noncoding RNA molecular signatures

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Santhilal Subhash ◽  
Norman Kalmbach ◽  
Florian Wegner ◽  
Susanne Petri ◽  
Torsten Glomb ◽  
...  
Keyword(s):  
Noncoding Rna ◽  
Vascular Malformations ◽  
Cerebrovascular Disorders ◽  
Gene Set Enrichment Analysis ◽  
Differentially Expressed ◽  
Low Flow ◽  
Pcr Analysis ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Non Coding Rnas

AbstractCerebral cavernous malformations (CCMs) are low-flow vascular malformations in the brain associated with recurrent hemorrhage and seizures. The current treatment of CCMs relies solely on surgical intervention. Henceforth, alternative non-invasive therapies are urgently needed to help prevent subsequent hemorrhagic episodes. Long non-coding RNAs (lncRNAs) belong to the class of non-coding RNAs and are known to regulate gene transcription and involved in chromatin remodeling via various mechanism. Despite accumulating evidence demonstrating the role of lncRNAs in cerebrovascular disorders, their identification in CCMs pathology remains unknown. The objective of the current study was to identify lncRNAs associated with CCMs pathogenesis using patient cohorts having 10 CCM patients and 4 controls from brain. Executing next generation sequencing, we performed whole transcriptome sequencing (RNA-seq) analysis and identified 1,967 lncRNAs and 4,928 protein coding genes (PCGs) to be differentially expressed in CCMs patients. Among these, we selected top 6 differentially expressed lncRNAs each having significant correlative expression with more than 100 differentially expressed PCGs. The differential expression status of the top lncRNAs, SMIM25 and LBX2-AS1 in CCMs was further confirmed by qRT-PCR analysis. Additionally, gene set enrichment analysis of correlated PCGs revealed critical pathways related to vascular signaling and important biological processes relevant to CCMs pathophysiology. Here, by transcriptome-wide approach we demonstrate that lncRNAs are prevalent in CCMs disease and are likely to play critical roles in regulating important signaling pathways involved in the disease progression. We believe, that detailed future investigations on this set of identified lncRNAs can provide useful insights into the biology and, ultimately, contribute in preventing this debilitating disease.

Unique enlarging cavernous malformation secondary to abnormal arteriovenous shunting through an associated developmental venous anomaly

2021 ◽  
pp. 197140092110428
Author(s):  
Nimisha Parikh ◽  
Richard Williamson ◽  
Matthew Kulzer ◽  
Albert Sohn ◽  
Warren M Chang ◽  
...  
Keyword(s):  
Unusual Case ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Venous Hypertension ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Arteriovenous Shunting ◽  
Cavernous Malformations ◽  
Progressive Growth

Cavernous malformations are angiographically occult vascular malformations. They are often associated with a developmental venous anomaly through poorly understood mechanisms. We present an unusual case of a gradually enlarging cavernous malformation associated with a developmental venous anomaly with arteriovenous shunting, suggesting venous hypertension or reflux as a potential cause of progressive growth.

The Juxtaposition of a Capillary Telangiectasia, Cavernous Malformation, and Developmental Venous Anomaly in the Brainstem of a Single Patient: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1246-1250 ◽  
Author(s):  
Richard E. Clatterbuck ◽  
İlhan Elmacı ◽  
Daniele Rigamonti
Keyword(s):  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Magnetic Resonance Imaging Examination ◽  
Developmental Venous Anomaly ◽  
Venous Malformations ◽  
Venous Anomaly ◽  
Single Patient ◽  
Cavernous Malformations ◽  
Swallowing Problems ◽  
Capillary Telangiectasia

ABSTRACT OBJECTIVE AND IMPORTANCE Capillary telangiectasias, cavernous malformations, and developmental venous anomalies are all vascular malformations that occur on the capillary-venous side of the cerebral circulation. The associations of capillary telangiectasias with venous malformations, cavernous malformations with venous malformations, and capillary telangiectasias with cavernous malformations have all been described; however, the association of all three lesions in a single patient is extremely rare. CLINICAL PRESENTATION A 52 year-old Caucasian woman presented to our clinic with an extended history of confusion, distorted visual perceptions, photophobia, neck pain, swallowing problems, and poor balance. The patient's examination was remarkable for difficulty concentrating, mild rotatory nystagmus, subtle decreased sensation over the left side of the face and body, and brisk reflexes. Review of the patient's magnetic resonance imaging examination demonstrated a cavernous malformation, a capillary telangiectasia, and a developmental venous anomaly located adjacent to one another in the brainstem. INTERVENTION Given the patient's complex constellation of symptoms and relatively mild neurological findings, it was difficult to ascribe any one of them to a specific vascular malformation. Conservative management of this patient's vascular malformations was decided upon. CONCLUSION Juxtaposition of these three different vascular lesions in the brainstem of an otherwise normal individual suggests a relationship among them. Although there are several theories that link similar associations through physiological mechanisms such as venous hypertension, we propose that a developmental event disrupting local capillary-venous pattern formation is a plausible alternative.

Are cavernous sinus hemangiomas and cavernous malformations different entities?

2006 ◽  
Vol 21 (1) ◽  
pp. 1-5 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Gregory P. Lekovic ◽  
Jennifer Eschbacher ◽  
Stephen Coons ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Response To Treatment ◽  
Vascular Tumors ◽  
Cerebral Cavernous Malformations ◽  
Imaging Studies ◽  
Cavernous Malformations ◽  
Cavernous Hemangiomas

✓Cavernous hemangiomas that occur within the cavernous sinus (CS) are different from cerebral cavernous malformations (CMs) clinically, on imaging studies, and in their response to treatment. Moreover, CMs are true vascular malformations, whereas hemangiomas are benign vascular tumors. Because of these differences, the authors suggest that these two entities be analyzed and grouped separately. Unfortunately, despite these differences, much confusion exists in the literature as to the nature, behavior, and classification of these two distinct lesions. This confusion is exacerbated by subtle histological differences and the inconsistent use of nomenclature. The authors use the term “cavernous malformation” to refer to intraaxial lesions only; they prefer to use the term “cavernous sinus hemangioma” to refer to extraaxial, intradural hemangiomas of the CS.

scholarly journals An Occipital Headache as the First Presentation of Multiple Third, Fourth, and Lateral Ventricular Cavernous Malformations: A Case Report and Review of Literature

2017 ◽  
Vol 6 (1) ◽  
pp. 61-65
Author(s):  
Alireza Vakilian ◽  
Amir Moghadam Ahmadi ◽  
Habib Farahmand
Keyword(s):  
Surgical Intervention ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Case Reports ◽  
Review Of Literature ◽  
Rare Presentation ◽  
Cavernous Malformations ◽  
Cavernous Hemangiomas ◽  
Occipital Headache ◽  
Tomography Scan

Background: Cavernous hemangiomas are common benign vascular malformations. Their existence in the intraventricular region is very rare. Case Reports: A 43-year old woman with an occipital headache was admitted to the emergency ward. Brain computed tomography scan showed mild hydrocephalus and multiple intraventricular isodense lesions. Imaging findings, especially of Gradient Resonance Echo imaging, were in favor of multiple intraventricular cavernous malformations. Conclusion: This is a rare presentation of multiple cavernous malformation as occipital headache without needing surgical intervention in this phase. Coexistence of periventricular plaques like Radiologically isolated syndrome of Multiple sclerosis is another unique aspect in this report. [GMJ.2017;6(1):61-65]

Progressive Quadriplegia

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Clinical Presentation ◽  
Vascular Malformations ◽  
Spinal Cord Ischemia ◽  
Rare Entity ◽  
Resonance Imaging ◽  
Anterior Spinal Artery Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
Aortic Dissections

Spinal cord ischemia most often presents as an anterior spinal artery syndrome and involves watershed regions of the spinal cord. The clinical presentation and etiologies can be heterogeneous, but cord infarcts are typically the result of aortic surgeries, systemic hypotension, vertebral artery and aortic dissections, embolus, or vascular malformations. Given that it is a rare entity, involving symptoms that can progress over minutes to hours, a diagnosis is often delayed until after conventional windows for revascularization, including thrombolysis, have passed. Magnetic resonance imaging (MRI) is usually required to confirm the diagnosis.

Diagnostic Accuracy of SWAN in the Diagnosis of Low-Flow Brain Vascular Malformations in Childhood

2021 ◽  
Author(s):  
Nazlı Gülsüm Akyel ◽  
Ayşe Gül Alımlı ◽  
Mesut Sivri ◽  
Havva Akmaz Ünlü ◽  
Mehmet Tiftik
Keyword(s):  
Diagnostic Accuracy ◽  
Vascular Malformations ◽  
False Negative ◽  
Vascular Anomaly ◽  
Low Flow ◽  
Developmental Venous Anomaly ◽  
Cavernous Malformations ◽  
Capillary Telangiectasia ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Abstract Purpose The main objective of this study is to demonstrate the diagnostic accuracy of susceptibility-weighted angiography (SWAN) in the diagnosis of slow-flow cerebral vascular malformations, especially developmental venous anomaly (DVA). We also aimed to determine the prevalence of DVAs identified by SWAN at 1.5 T. Methods We retrospectively evaluated 1,760 axial SWAN images for the diagnosis of low-flow vascular anomaly. Among them were 305 patients who underwent contrast-enhanced examination due to different indications. Postcontrast images were analyzed by different radiologists who were blinded to patients. The presence of DVA and other features such as location, length, depth, and direction of drainage vein was evaluated. Results Twenty-six patients with DVA had both SWAN and postcontrast images. There were four false-negative patients with SWAN. The sensitivity of the SWAN sequence was 84.6%. In addition, totally 77 DVA (4.36%), 2 capillary telangiectasia (0.11%), and 2 cavernous malformations (0.11%) were detected in 1,760 patients. Conclusion SWAN is an effective method for the diagnosis of developmental venous anomalies and other low-flow cerebral vascular malformations. Especially in the pediatric age, susceptibility-weighted imaging sequences are useful to limit contrast use.

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