TY - ECHAP DO - 10.1055/b-0038-162193 SN - 9781684200573 SN - 9781626237780 LA - EN TI - 64 Supratentorial Cavernous Malformations PB - Georg Thieme Verlag KG CY - Stuttgart PY - 2018 UR - http://www.thieme-connect.de/products/ebooks/lookinside/10.1055/b-0038-162193 DA - 2018/06/28 KW - supratentorial KW - cavernous malformation KW - hemorrhage KW - epilepsy KW - craniotomy KW - asymptomatic KW - microsurgery KW - observation AB - The supratentorial compartment represents the predominant location for cavernous malformations of the brain. These lesions may be found incidentally with the ubiquitous use of advanced imaging or be found in patients presenting with seizures, hemorrhage or focal neurological deficits. Asymptomatic lesions can be monitored with clinical and radiological follow-up while symptomatic lesions are treated based on multiple factors including presentation, location, associated deficits, seizure localization and other patient and lesion specific factors weighing the risks of treatment against the anticipated benefits. Lesions presenting with hemorrhage or lesion-related seizures/epilepsy amenable to resection can be treated via craniotomy and resection with microsurgical technique. Lesions presenting with an initial hemorrhage in a deep or eloquent region may be observed, with surgery or radio-surgery reserved for recurrent hemorrhage depending upon patient and lesion-specific considerations. Pre-operative advanced imaging including functional and diffusion-tensor imaging with tractography, neuronavigation, meticulous microsurgical technique and intraoperative monitoring can make surgical resection safer and more effective with lesions located in deep and/or eloquent locations. An algorithm is presented to facilitate the management of patients harboring supratentorial cavernous malformations. T2 - Decision Making in Neurovascular Disease ER -