Remarkable Clinical Improvement Following Microsurgical Resection of Left Lingual Gyrus Cerebral Cavernous Malformation: A Case Report

Abstract

Introduction Cerebral cavernous malformations (CCMs) are collections of dilated and irregular capillaries in the brain. Cerebral cavernous malformations are predominantly supratentorial; occipital CCMs are rare. Surgical removal is indicated for CCMs with recurrent hemorrhage, refractory seizures, and expanding lesions.

Case Description We describe a case of a 15-year-old male who presented with repeated tonic-clonic seizures and right homonymous hemianopia of 3-week duration. Magnetic resonance imaging (MRI) showed a mass located on the left medial occipital lobe, specifically in the left lingual gyrus. The T2-weighted and T2-gradient echo images confirmed the diagnosis of a CCM. Total microscopic resection was achieved. There were no surgical complications. The visual deficit improved, and the patient was seizure-free on subsequent follow-up visits.

Conclusion Surgical resection of an occipital CCM resulted in a remarkable improvement in terms of seizures and visual field deficits.

Keywords

cerebral cavernous malformations - left lingual gyrus - microsurgical resection

Publikationsverlauf

Eingereicht: 04. April 2020

Angenommen: 05. August 2020

Artikel online veröffentlicht:
16. Oktober 2020

• References

• 1 Requena I, Arias M, López-Ibor L. et al. Cavernomas of the central nervous system: clinical and neuroimaging manifestations in 47 patients. J Neurol Neurosurg Psychiatry 1991; 54 (07) 590-594
• 2 Cortés Vela JJ, Concepción Aramendía L, Ballenilla Marco F, Gallego León JI, González-Spínola San Gil J. Cerebral cavernous malformations: spectrum of neuroradiological findings. Radiologia (Madr) 2012; 54 (05) 401-409
• 3 Cohen DS, Zubay GP, Goodman RR. Seizure outcome after lesionectomy for cavernous malformations. J Neurosurg 1995; 83 (02) 237-242
• 4 Awad I, Jabbour P. Cerebral cavernous malformations and epilepsy. Neurosurg Focus 2006; 21 (01) e7
• 5 Awad IA, Robinson JR. Cavernous malformations and epilepsy, in Awad IA, Barrow DL (eds): Cavernous Malformations. Park Ridge, IL: American Association of Neurological Surgeons; 1993: 49-64
• 6 Menzler K, Chen X, Thiel P. et al. Epileptogenicity of cavernomas depends on (archi-) cortical localization. Neurosurgery 2010; 67 (04) 918-924
• 7 Russel DS, Rubinstein LJ. 1989. Tumours and hamartomas of the blood vessels. In: The pathology of tumours of the nervous system, 5th edn. Edward Arnold, London: 727-790
• 8 Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma. J Neurosurg 1991; 75 (05) 709-714
• 9 Del Curling Jr O, Kelly Jr DL, Elster AD, Craven TE. An analysis of the natural history of cavernous angiomas. J Neurosurg 1991; 75 (05) 702-708
• 10 Gomori JM, Grossman RI, Goldberg HI, Hackney DB, Zimmerman RA, Bilaniuk LT. Occult cerebral vascular malformations: high-field MR imaging. Radiology 1986; 158 (03) 707-713
• 11 Ferroli P, Casazza M, Marras C, Mendola C, Franzini A, Broggi G. Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy. Neurol Sci 2006; 26 (06) 390-394
• 12 Kahane P, Munari C, Hoffmann D. et al. Approche chirurgicale multimodale des angiomes caverneux épileptogènes. Epilepsies 1994; 6: 113-130
• 13 Kivelev J, Koskela E, Setälä K, Niemelä M, Hernesniemi J. Long-term visual outcome after microsurgical removal of occipital lobe cavernomas. J Neurosurg 2012; 117 (02) 295-301
• 14 Akers A, Al-Shahi Salman R, A-Awad I. et al. Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel. Neurosurgery 2017; 80 (05) 665-680
• 15 Zafar A, Quadri SA, Farooqui M. et al. Familial Cerebral Cavernous Malformations. Stroke 2019; 50 (05) 1294-1301
• 16 Kim J. Introduction to cerebral cavernous malformation: a brief review. BMB Rep 2016; 49 (05) 255-262
• 17 Choquet H, Pawlikowska L, Lawton MT, Kim H. Genetics of cerebral cavernous malformations: current status and future prospects. J Neurosurg Sci 2015; 59 (03) 211-220
• 18 Winkler EA, Rutledge C, Ward M. et al. Radiation-induced Cavernous Malformation as a Late Sequelae of Stereotactic Radiosurgery for Epilepsy. Cureus 2018; 10 (03) e2308-e2308
• 19 Fritschi JA, Reulen HJ, Spetzler RF, Zabramski JM. Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir (Wien) 1994; 130 (1-4): 35-46
• 20 Horne MA, Flemming KD, Su IC. Cerebral Cavernous Malformations Individual Patient Data Meta-analysis Collaborators. et al. Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data. Lancet Neurol 2016; 15 (02) 166-173
• 21 Poorthuis MH, Klijn CJ, Algra A, Rinkel GJ, Al-Shahi Salman R. Treatment of cerebral cavernous malformations: a systematic review and meta-regression analysis. J Neurol Neurosurg Psychiatry 2014; 85 (12) 1319-1323
• 22 Kamezawa T, Hamada J, Niiro M, Kai Y, Ishimaru K, Kuratsu J. Clinical implications of associated venous drainage in patients with cavernous malformation. J Neurosurg 2005; 102 (01) 24-28
• 23 Mouchtouris N, Chalouhi N, Chitale A. et al. Management of cerebral cavernous malformations: from diagnosis to treatment. ScientificWorldJournal 2015; 2015: 808314
• 24 Chohan MO, Marchiò S, Morrison LA. et al. Emerging Pharmacologic Targets in Cerebral Cavernous Malformation and Potential Strategies to Alter the Natural History of a Difficult Disease: A Review. JAMA Neurol 2019; 76 (04) 492-500