Cavernous angiomas: An uncontrolled clinical study of 87 surgically treated patients

Background. Cerebral cavernous angiomas remain as one of the most negotiable and controversial topics in neurological and neurosurgical practice. We present statistical evaluation of initial presentation, preoperative neurological findings, surgical complications, and outcome of surgically treated patients with intracerebral cavernous angiomas.
Methods. During 1997 to 2004, 87 patients (41 men, 46 women) with intracerebral cavernous angiomas underwent surgical treatment in the tertiary referral center, and these were included into the present uncontrolled clinical study. The mean age of the patients at the time of operation was 42.4 years, and the mean duration of illness was 120.5 days. All patients underwent preoperative magnetic resonance imaging, and pre- and postoperative clinical examination. The clinical course was documented using the Karnofski performance scale. A simplified version of Engel’s classification of the outcome of the patients with chronic seizures was applied.
Results. The most common clinical presentation of cavernous angiomas was seizures, significant part of which was chronic. No association was found between lesion location by cerebral lobes and clinical presentation by seizures. No significant differences in the likelihood of presenting with hemorrhage between supratentorial and subtentorial lesions were detected. In addition, no associations were found between size of cavernoma and the initial presentation of cavernoma by an extralesional hemorrhage or chronic seizures. In the group of patients presenting with headache, sporadic seizures, or intracerebral hemorrhage, good postoperative outcome was achieved in 83% of the patients. Of the patients who underwent operation for seizure control, significant seizure reduction or elimination after surgery was observed in 79% of the patients.
Conclusions. Microsurgical removal of cavernous angiomas and surrounding hemosiderin plate tends to significant reduction or elimination of epileptic seizures and improved postoperative neurological status.