Management of Intracranial Cavernous Malformation: A Retrospective Analysis of 76 Consecutive Cases.

Kim, Tae Gon; Huh, Seung Kon; Lee, Kyu Chang; Kim, Se Hyuk; Kim, Dong Suk; Park, Yong Guo; Choi, Joong Uhn; Chung, Sang Sub

Original Article

Journal of Korean Neurosurgical Society 2002;31(2): 145-151.

Tae Gon Kim, Seung Kon Huh, Kyu Chang Lee, Se Hyuk Kim, Dong Suk Kim, Yong Guo Park, Joong Uhn Choi, Sang Sub Chung

Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

OBJECTIVE
To establish a treatment guideline for intracranial cavernous malformation, the authors analyzed the clinical features, treatment modality, complications, and late outcomes in 76 consecutive cases (45 microsurgical resections, 30 stereotactic radiosurgeries, one microsurgery followed by radiosurgery) managed at the Yonsei University Medical Center from 1985 to 1998.
RESULTS
Among 104 lesions in 76 patients, 64(61.5%) lesions were supratentorial and 40(38.5%) infratentorial. Hemorrhage was the most common presentation(31 patients, 40.8%), followed by generalized seizure(15 patients, 19.7%). Fifteen(19.7%) patients had mixed presentation with generalized seizure and hemorrhage, while 9(11.9%) patients presented focal deficits. The remaining 6(7.9%) patients had headache or incidental lesion. Almost all infratentorial lesions(92.5%) were managed with radiosurgery, and 65.6% of supratentorial lesions with microsurgery. The average follow-up period was 14.6 months for the microsurgery group and 32 months for the radiosurgery group. The overall outcome was good in 68(89.5%), fair in 6(7.9%), poor in 1(1.3%), and dead in 1(1.3%). Total microsurgical resection and symptomatic cure rate was 95.6%. Two lesion were incompletely resected. One lesion was followed by radiosurgery and the other was followed by reoperation. Only 38.5% of lesions with radiosurgery were shrunken.
CONCLUSION
Microsurgical removal is effective for lesions in the non-eloquent area, or with recurrent hemorrhages and seizures. Although radiosurgery could be considered for lesions with multiplicity in the eloquent or deep-seated area, further study for the radiosurgical effect on cavernous malformations is required.

Key Words: Cavernous malformation; Intracranial hemorrhage; Seizure; Management