TREATMENT IN CAVERNOUS ANGIOMA

Cavernous angiomas can be clinically silent, and since their natural course is usually benign, treatment is quite controversial. A group of 32 patients with 55 cavernous angiomas and a mean age of 37 years is presented. Only 6 of these patients presented cavernous angiomas with multiple locations and single cavernous angiomas were seen in 26 patients. The patients presented with epilepsy in 14 cases (43.7%); hemorrhage in 11 (34.3%); headaches in 11 (34.3%); and motor deficit in 10 (31.2%). Neuroradiological studies included angiography in 4 cases, angiography plus CT in 7 cases, angiography plus CT and MR in 14 cases, and CT plus MR in 7 cases. Of the 32 patients, 23 were operated and 9 were managed conservatively. The outcome of surgery in the 23 operated patients was good in 17 (73%), fair in 5 (22%) and poor in one patient who had a massive hemorrhage. Only one of the unoperated patients did poorly and he was the only one who had received radiosurgery. These 32 patients with 55 cavernous angiomas were followed during an average period of 5.3 years. The annual incidence of bleeding was 1% (two non operated patients bled and one patient bled several months after partial removal). We concluded that surgery is indicated when the cavernous angiomas cause hemorrhage or refractory epilepsy, provided that they are in a favourable location.