Intraventricular Cavernous Malformation: Review of the Literature and Report of Three Cases with Neuroendoscopic Resection

Abstract

Intraventricular cavernomas (IVCs) are extremely infrequent and only occur in 2.8 to 10% of patients with cerebral cavernomas. We describe three IVC cases and briefly review previously documented IVC cases in PubMed. Among 136 IVC cases, the mean age of the patients was 36.5 years; the male-to-female ratio was 0.8. The most frequent location was the lateral ventricle (52.6%), and most of the clinical symptoms (74%) were related to mass effects on adjacent brain tissues. Intraventricular hemorrhage occurred in 22.9% of cases. Most of the articles concluded that complete surgical resection is the treatment of choice.

The microsurgical approach is currently considered the gold standard for IVC resection. Using the neuroendoscope and neuronavigational guidance and based on the biological characteristics of the IVC, proper lesion size, and dilated ventricles, we totally resected the lesion in all three cases.

Neuroendoscopy can be considered as an alternative to microsurgery of IVCs. However, we believe a larger series of cases is necessary to demonstrate when microsurgery and when neuroendoscopy should be performed for IVC resection.

Keywords

cavernous malformation - intraventricular cavernomas - microsurgery - neuroendoscopy

• References

• 1 Zabramski JM, Feiz-Erfan I. Natural history of cavernous malformations. In: Winn RH, , ed. Youmans Neurological Surgery. Philadelphia, PA: Elsevier; 2011: 4114-4126
• 2 Kivelev J, Niemelä M, Kivisaari R, Hernesniemi J. Intraventricular cerebral cavernomas: a series of 12 patients and review of the literature. J Neurosurg 2010; 112 (1) 140-149
• 3 Bilginer B, Narin F, Hanalioglu S, Oguz KK, Soylemezoglu F, Akalan N. Cavernous malformations of the central nervous system (CNS) in children: clinico-radiological features and management outcomes of 36 cases. Childs Nerv Syst 2014; 30 (8) 1355-1366
• 4 Suess O, Hammersen S, Brock M. Intraventricular cavernoma: unusual occurrence in the region of the foramen of monro. Br J Neurosurg 2002; 16 (1) 78-79
• 5 Winslow N, Abode-Iyamah K, Flouty O, Park B, Kirby P, Howard III M. Intraventricular foramen of Monro cavernous malformation. J Clin Neurosci 2015; 22 (10) 1690-1693
• 6 Lee BJ, Choi CY, Lee CH. Intraventricular cavernous hemangiomas located at the foramen of Monro. J Korean Neurosurg Soc 2012; 52 (2) 144-147
• 7 Faropoulos K, Panagiotopoulos V, Partheni M, Tzortzidis F, Konstantinou D. Therapeutic management of intraventricular cavernoma: case series and review of the literature. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (3) 233-239
• 8 Han MS, Moon KS, Lee KH, Kim SK, Jung S. Cavernous hemangioma of the third ventricle: a case report and review of the literature. World J Surg Oncol 2014; 12: 237
• 9 Ohbuchi H, Osaka Y, Ogawa T , et al. Trigonal cavernous malformation with intraventricular hemorrhage: a case report and literature review. J Med Invest 2012; 59 (3–4): 275-279
• 10 Vandesteen L, Drier A, Galanaud D , et al. Imaging findings of intraventricular and ependymal lesions. J Neuroradiol 2013; 40 (4) 229-244
• 11 Demir MK, Yapıcıer O, Onat E , et al. Rare and challenging extra-axial brain lesions: CT and MRI findings with clinico-radiological differential diagnosis and pathological correlation. Diagn Interv Radiol 2014; 20 (5) 448-452
• 12 Bhatia S, Kapoor AK, Gupta R, Sahni T. Cavernous hemangioma located at the foramen of Monro: radiopathological correlation. Indian J Radiol Imaging 2013; 23 (3) 202-204
• 13 Reyns N, Assaker R, Louis E, Lejeune JP. Intraventricular cavernomas: three cases and review of the literature. Neurosurgery 1999; 44 (3) 648-654 ; discussion 654–655
• 14 Finkelnburg R. Zur Differentialdiagnose zwischen Kleinhirntumoren und chronischen Hydrocephalus (Zugleich ein Beitrag zur Kenntnis der Angiome des Zentralnervensystems). Dtsch Z Nervenheilkd 1905; 29: 135-151
• 15 Carrasco R, Pedrosa M, Pascual JM, Navas M, Liberal R, Sola RG. Cavernous angiomas of the lateral ventricles. Acta Neurochir (Wien) 2009; 151 (2) 149-154
• 16 McConnell TH, Leonard JS. Microangiomatous malformations with intraventricular hemorrhage. Report of two unusual cases. Neurology 1967; 17 (6) 618-620
• 17 Katayama Y, Tsubokawa T, Maeda T, Yamamoto T. Surgical management of cavernous malformations of the third ventricle. J Neurosurg 1994; 80 (1) 64-72
• 18 Pozzati E, Gaist G, Poppi M, Morrone B, Padovani R. Microsurgical removal of paraventricular cavernous angiomas. Report of two cases. J Neurosurg 1981; 55 (2) 308-311
• 19 Harbaugh RE, Roberts DW, Fratkin JD. Hemangioma calcificans. Case report. J Neurosurg 1984; 60 (2) 417-419
• 20 Yamasaki T, Handa H, Yamashita J , et al. Intracranial and orbital cavernous angiomas. A review of 30 cases. J Neurosurg 1986; 64 (2) 197-208
• 21 Ogawa A, Katakura R, Yoshimoto T. Third ventricle cavernous angioma: report of two cases. Surg Neurol 1990; 34 (6) 414-420
• 22 Andoh T, Shinoda J, Miwa Y , et al. Tumors at the trigone of the lateral ventricle—clinical analysis of eight cases. Neurol Med Chir (Tokyo) 1990; 30 (9) 676-684
• 23 Itoh J, Usui K. Cavernous angioma in the fourth ventricular floor—case report. Neurol Med Chir (Tokyo) 1991; 31 (2) 100-103
• 24 Sinson G, Zager EL, Grossman RI, Gennarelli TA, Flamm ES. Cavernous malformations of the third ventricle. Neurosurgery 1995; 37 (1) 37-42
• 25 Veto F, Horváth Z, Dóczi T. Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note. Neurosurgery 1997; 40 (4) 871-875 ; discussion 875–877
• 26 Gaab MR, Schroeder HWS. Neuroendoscopic approach to intraventricular lesions. J Neurosurg 1998; 88 (3) 496-505
• 27 Crivelli G, Dario A, Cerati M, Dorizzi A. Third ventricle cavernoma associated with venous angioma. Case report and review of the literature. J Neurosurg Sci 2002; 46 (3-4): 127-130
• 28 Darwish B, Boet R, Finnis N, Smith N. Third ventricular cavernous haemangioma. J Clin Neurosci 2005; 12 (5) 601-603
• 29 Bulluss KJ, Wood M, Smith P, Trost N, Murphy MA. Cavernous haemangioma presenting with obstructive hydrocephalus. J Clin Neurosci 2005; 12 (6) 660-663
• 30 Longatti P, Fiorindi A, Perin A, Baratto V, Martinuzzi A. Cavernoma of the foramen of Monro. Case report and review of the literature. Neurosurg Focus 2006; 21 (1) e13
• 31 Sato K, Oka H, Utsuki S, Shimizu S, Suzuki S, Fujii K. Neuroendoscopic appearance of an intraventricular cavernous angioma blocking the foramen of Monro—case report. Neurol Med Chir (Tokyo) 2006; 46 (11) 548-551
• 32 Prat R, Galeano I. Endoscopic resection of cavernoma of foramen of Monro in a patient with familial multiple cavernomatosis. Clin Neurol Neurosurg 2008; 110 (8) 834-837
• 33 Meilán Martínez A, Vega Valdés P, Santamarta Liébana E, Rial Basalo JC. Intraventricular cavernoma in the foramen of Monro: particularities due to its atypical location. [in Spanish]. Radiologia 2009; 51 (6) 605-609
• 34 Juretschke FR, Güresir E, Marquardt G , et al. Trigonal and peritrigonal lesions of the lateral ventricle—surgical considerations and outcome analysis of 20 patients. Neurosurg Rev 2010; 33 (4) 457-464
• 35 Giannetti AV. Purely neuroendoscopic resection of an intraventricular cavernous angioma: case report. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (1) 47-50
• 36 Mazher S, Imran M, Ashraf J, Ahmed A, Shah IU, Zulfiqar F. Outcome of open transcortical approach in the management of intraventricular lesions. J Coll Physicians Surg Pak 2013; 23 (12) 857-861
• 37 Chourmouzi D, Kaltsikis I, Zountsas B, Drevelegas A. Third ventricle cavernoma associated with multiple intracerebral cavernomas. Acta Neurol Belg 2013; 113 (1) 99-101
• 38 Patibandla MR, Thotakura AK, Panigrahi MK. Third ventricular cavernous malformation: an unusual lesion. Br J Neurosurg 2014; 28 (1) 110-112
• 39 Hassani FD, Gana R, El Abbadi N, El Fatemi N, Maaqili MR. Cavernoma of the fourth ventricle: report of a case and review of the literature. [in French]. Pan Afr Med J 2014; 18: 331
• 40 Prabhuraj AR, Shukla D. Third ventricular cavernoma: Report of two cases. J Neurosci Rural Pract 2014; 5 (Suppl. 01) S99-S100
• 41 Arnstein LH, Boldrey E, Naffziger HC. A case report and survey of brain tumors during the neonatal period. J Neurosurg 1951; 8 (3) 315-319
• 42 Pau A, Orunesu G. Vascular malformations of the brain in achondroplasia. Case report. Acta Neurochir (Wien) 1979; 50 (3–4): 289-292
• 43 Tatagiba M, Schönmayr R, Samii M. Intraventricular cavernous angioma. A survey. Acta Neurochir (Wien) 1991; 110 (3–4): 140-145
• 44 Milligan BD, Meyer FB. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery 2010; 67 (6) 1483-1496 ; discussion 1496
• 45 Schroeder HW, Gaab MR. Intracranial endoscopy. Neurosurg Focus 1999; 6 (4) e1
• 46 Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg 2013; 2013: 898753
• 47 Russo N, Brunori A, Delitala A. Endoscopic approaches to intraventricular lesions. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (5) 353-360
• 48 Schroeder HW. General principles and intraventricular neuroendoscopy: endoscopic techniques. World Neurosurg 2013; 79 , (2 Suppl): 14.e23-14.e28