Cavernous Hemangioma of the Central Nervous System

Seven surgical cases of cavernous hemangioma (cavernoma) of the CNS was analysed. Of these cases, one was intracerebral (intraventricular), three extracerebral in the middle fossa, one intraspinal intramedullary (C4-6), and two intraspinal extradural (T4-6, T5-6). The age of the patient on admission ranged from 9 to 62 years, mostly over 40 years. The duration of the symptoms before admission ranged from 1.5 months to 11 years. Sudden onset of the illness suggesting a hemorrhage in or around the tumor was found in 2 cases. The signs and symptoms in all patients were divided into three groups, namely, those of increased intracranial pressure, of local compression, and of hemorrhage. The plain X-ray films revealed abnormalities in all but an intraspinal extradural case. RI scan was done in 2 intracranial cases showing a positive uptake in both cases. CT scan was done in a case of the middle fossa and revealed a slightly high density area which was markedly enhanced with contrast media. Angiography was done in all intracranial cases and in a cervical intramedullary case. The commonest finding in the intracranial cavernomas was an avascular mass lesion with or without faint tumor stain. However, in a case of the middle fossa the avascular mass on conventional angiography turned to a vascular mass on angiography with more contrast media (15 ml) and longer injection time (4 sec.). We called this method prolonged (or slow) injection angiography. Small venous poolings at the site of tumor were noted in an intracerebral case by conventional angiography. Neuroradiologic diagnosis of cavernoma of the CNS would be attained by the findings, 1. localized hot area in RI scan, 2. high density area with definite contrast enhancement in CT scan, 3. avascular or hypovascular mass lesion with no or poor visualization of feeding arteries in conventional angiography, 4. presence of venous poolings at the site of tumor, and 5. visualization of fine neovascularity or tumor stain in prolonged injection angiography. Removal of the tumor was total in an intracerebral case and intraspinal extradural cases, but was partial in cases of the middle fossa and an intraspinal intramedullary case. It was stressed that correct preoperative diagnosis would be very important because total removal was at all impossible and would therefore not have been indicated in some cases.