Management of Incidental Cerebral Cavernous Angiomas:our experience

Introduction. With the advent of high-resolution com-puted tomography and magnetic resonance imaging,the frequency of intracranial incidentalomas has beengreatly increased. Cavernous malformations (CMs) areangiographically occult vascular malformations whichmay cause symptomatic intracranial hemorrhage, seizu-res and focal neurological deficits. The incidence ofsymptomatic CMs is ranging between 69-88% of cases.Despite this symptomatic presentation, these lesionsare sometimes found incidentally on MR imaging. 12-31% of cavernomas are clinically asymptomatic andcan be discovered only incidentally. Treatment is repre-sented by surgical removal of the lesion, radiosurgeryor clinical and MRI follow-up.Objects. The aim of our study was to present our expe-rience and our treatment strategy in the managementof incidental CMs.Material and Methods. A total of 57 patients with CMswere investigated. The cohort included 43 patients(75,6%) with symptomatic CMs and 14 patients (24,6%)with incidental CMs. This last group included 10 fema-les and 4 males with a mean age of 48 years (range 20-71 years). The incidental detection was consequent toneuroradiological investigations after head injury in 10patients (72%), endocrinological disorders in 2 patien-ts, stadiation for lung cancer in 1 patient and in thefollow-up of an intracranial embolized aneurysm in 1case. Most incidental CMs were localized in the supra-tentorial area (72%). Lesion size was predominatelybelow 1,5 cm (range 0.5 - 3 cm).Results and Conclusions. Among patients with inci-dental CMs, 6 patients (42%) underwent surgical treat-ment (mean age 46 years, 5 cases with supratentoriallocation and 1 case with cerebellar location), while 8patients (56%) were treated conservatively (mean age50 years, 4 cases with supratentorial deep location, 3cases with brainstem location and 1 patient with multi-ple cavernomatosis.)In the management of incidentally discovered caverno-mas it is important the appropriate selection of thepatients. We propose a radical surgical resection forasymptomatic CMs in non-eloquent areas. Asympto-matic cerebral cavernomas in critical areas should befollowed-up with brain MRI in old patients or patients inpoor general conditions or in those with multiple deeplocations. CMs incidentalomas in eloquent areas inyoung healthy patients should be accurately selected in each patient