CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(03): 511-521
DOI: 10.1055/s-0044-1779587
Review Article

Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics

1   Clinic of Radiology, Bahcesehir University Goztepe Medical Park Hospital, Istanbul, Turkey
,
2   Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
,
2   Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
,
2   Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
› Author Affiliations
Funding None.

Abstract

Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions.

Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive.

Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult.

Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.



Publication History

Article published online:
28 February 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Konya D, Yildirim O, Kurtkaya O. et al. Testing the angiogenic potential of cerebrovascular malformations by use of a rat cornea model: usefulness and novel assessment of changes over time. Neurosurgery 2005; 56 (06) 1339-1345 , discussion 1345–1346
  • 2 Bicer A, Guclu B, Ozkan A. et al. Expressions of angiogenesis associated matrix metalloproteinases and extracellular matrix proteins in cerebral vascular malformations. J Clin Neurosci 2010; 17 (02) 232-236
  • 3 Dammann P, Wrede KH, Maderwald S. et al. The venous angioarchitecture of sporadic cerebral cavernous malformations: a susceptibility weighted imaging study at 7 T MRI. J Neurol Neurosurg Psychiatry 2013; 84 (02) 194-200
  • 4 Brinjikji W, El-Masri AE, Wald JT, Flemming KD, Lanzino G. Prevalence of cerebral cavernous malformations associated with developmental venous anomalies increases with age. Childs Nerv Syst 2017; 33 (09) 1539-1543
  • 5 Ciricillo SF, Dillon WP, Fink ME, Edwards MS. Progression of multiple cryptic vascular malformations associated with anomalous venous drainage. Case report. J Neurosurg 1994; 81 (03) 477-481
  • 6 Maeder P, Gudinchet F, Meuli R, de Tribolet N. Development of a cavernous malformation of the brain. AJNR Am J Neuroradiol 1998; 19 (06) 1141-1143
  • 7 Ogilvy CS, Moayeri N, Golden JA. Appearance of a cavernous hemangioma in the cerebral cortex after a biopsy of a deeper lesion. Neurosurgery 1993; 33 (02) 307-309 , discussion 309
  • 8 Abdulrauf SI, Kaynar MY, Awad IA. A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery 1999; 44 (01) 41-46 , discussion 46–47
  • 9 Baumgartner JE, Ater JL, Ha CS. et al. Pathologically proven cavernous angiomas of the brain following radiation therapy for pediatric brain tumors. Pediatr Neurosurg 2003; 39 (04) 201-207
  • 10 Flocks JS, Weis TP, Kleinman DC, Kirsten WH. Dose-response studies to polyoma virus in rats. J Natl Cancer Inst 1965; 35 (02) 259-284
  • 11 Porter RW, Detwiler PW, Spetzler RF. et al. Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg 1999; 90 (01) 50-58
  • 12 Dashti SR, Hoffer A, Hu YC, Selman WR. Molecular genetics of familial cerebral cavernous malformations. Neurosurg Focus 2006; 21 (01) e2
  • 13 Labauge P, Denier C, Bergametti F, Tournier-Lasserve E. Genetics of cavernous angiomas. Lancet Neurol 2007; 6 (03) 237-244
  • 14 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
  • 15 Akers A, Al-Shahi Salman R, Awad IA. 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
  • 16 Pozzati E, Acciarri N, Tognetti F, Marliani F, Giangaspero F. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 1996; 38 (04) 662-669 , discussion 669–670
  • 17 Campbell PG, Jabbour P, Yadla S, Awad IA. Emerging clinical imaging techniques for cerebral cavernous malformations: a systematic review. Neurosurg Focus 2010; 29 (03) E6
  • 18 Rivera PP, Willinsky RA, Porter PJ. Intracranial cavernous malformations. Neuroimaging Clin N Am 2003; 13 (01) 27-40
  • 19 Zabramski JM, Wascher TM, Spetzler RF. et al. The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 1994; 80 (03) 422-432
  • 20 de Souza JM, Domingues RC, Cruz Jr LC, Domingues FS, Iasbeck T, Gasparetto EL. Susceptibility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with T2-weighted fast spin-echo and gradient-echo sequences. AJNR Am J Neuroradiol 2008; 29 (01) 154-158
  • 21 Haller S, Vernooij MW, Kuijer JPA, Larsson EM, Jäger HR, Barkhof F. Cerebral microbleeds: imaging and clinical significance. Radiology 2018; 287 (01) 11-28
  • 22 Menzler K, Chen X, Thiel P. et al. Epileptogenicity of cavernomas depends on (archi-) cortical localization. Neurosurgery 2010; 67 (04) 918-924
  • 23 Sone JY, Hobson N, Srinath A. et al. Perfusion and permeability MRI predicts future cavernous angioma hemorrhage and growth. J Magn Reson Imaging 2022; 55 (05) 1440-1449
  • 24 Kivelev J, Laakso A, Niemelä M, Hernesniemi J. A proposed grading system of brain and spinal cavernomas. Neurosurgery 2011; 69 (04) 807-813 , discussion 813–814
  • 25 Ellis JA, Barrow DL. Supratentorial cavernous malformations. Handb Clin Neurol 2017; 143: 283-289
  • 26 Kan P, Tubay M, Osborn A, Blaser S, Couldwell WT. Radiographic features of tumefactive giant cavernous angiomas. Acta Neurochir (Wien) 2008; 150 (01) 49-55 , discussion 55
  • 27 Lawton MT, Vates GE, Quinones-Hinojosa A, McDonald WC, Marchuk DA, Young WL. Giant infiltrative cavernous malformation: clinical presentation, intervention, and genetic analysis: case report. Neurosurgery 2004; 55 (04) 979-980
  • 28 Yu Q, Lin K, Liu Y, Li X. Clinical uses of diffusion tensor imaging fiber tracking merged neuronavigation with lesions adjacent to corticospinal tract: a retrospective cohort study. J Korean Neurosurg Soc 2020; 63 (02) 248-260
  • 29 Sarbu N, Pujol T, Oleaga L. Hyperintense perilesional edema in the brain on T1-weighted images: cavernous malformation or metastatic melanoma? Three case reports and literature review. Neuroradiol J 2016; 29 (01) 52-56
  • 30 Yun TJ, Na DG, Kwon BJ. et al. A T1 hyperintense perilesional signal aids in the differentiation of a cavernous angioma from other hemorrhagic masses. AJNR Am J Neuroradiol 2008; 29 (03) 494-500
  • 31 Kuroedov D, Cunha B, Pamplona J, Castillo M, Ramalho J. Cerebral cavernous malformations: typical and atypical imaging characteristics. J Neuroimaging 2023; 33 (02) 202-217
  • 32 Pinker K, Stavrou I, Szomolanyi P. et al. Improved preoperative evaluation of cerebral cavernomas by high-field, high-resolution susceptibility-weighted magnetic resonance imaging at 3 tesla: comparison with standard (1.5 T) magnetic resonance imaging and correlation with histopathological findings: preliminary results. Invest Radiol 2007; 42 (06) 346-351
  • 33 Yaghi S, Oomman S, Keyrouz SG. Non-aneurysmal perimesencephalic subarachnoid hemorrhage caused by a cavernous angioma. Neurocrit Care 2011; 14 (01) 84-85
  • 34 Negoto T, Terachi S, Baba Y, Yamashita S, Kuramoto T, Morioka M. Symptomatic brainstem cavernoma of elderly patients: timing and strategy of surgical treatment. Two case reports and review of the literature. World Neurosurg 2018; 111: 227-234
  • 35 Anqi X, Zhang S, Jiahe X, Chao Y. Cavernous sinus cavernous hemangioma: imaging features and therapeutic effect of Gamma Knife radiosurgery. Clin Neurol Neurosurg 2014; 127: 59-64
  • 36 Hsiang JN, Ng HK, Tsang RK, Poon WS. Dural cavernous angiomas in a child. Pediatr Neurosurg 1996; 25 (02) 105-108
  • 37 Ito M, Kamiyama H, Nakamura T, Nakajima H, Tokugawa J. Dural cavernous hemangioma of the cerebellar falx. Neurol Med Chir (Tokyo) 2009; 49 (09) 410-412
  • 38 Joshi V, Muzumdar D, Dange N, Goel A. Supratentorial convexity dural-based cavernous hemangioma mimicking a meningioma in a child. Pediatr Neurosurg 2009; 45 (02) 141-145
  • 39 Gonzalez LF, Lekovic GP, Eschbacher J, Coons S, Porter RW, Spetzler RF. Are cavernous sinus hemangiomas and cavernous malformations different entities?. Neurosurg Focus 2006; 21 (01) e6
  • 40 Foster KA, Ares WJ, Tempel ZJ. et al. PHACE syndrome is associated with intracranial cavernous malformations. Childs Nerv Syst 2016; 32 (08) 1463-1469
  • 41 Yoshinaga T, Yagi K, Morishita T, Abe H, Nonaka M, Inoue T. Cerebral and spinal cavernomas associated with Klippel-Trenaunay syndrome: case report and literature review. Acta Neurochir (Wien) 2018; 160 (02) 287-290
  • 42 Brinjikji W, Flemming KD, Lanzino G. De novo formation of a large cavernoma associated with a congenital torcular dural arteriovenous fistula: case report. J Neurosurg Pediatr 2017; 19 (05) 567-570
  • 43 Chen DJ, Severson E, Prayson RA. Cavernous angiomas in chronic epilepsy associated with focal cortical dysplasia. Clin Neuropathol 2013; 32 (01) 31-36
  • 44 Weigel J, Neher M, Schrey M, Wünsch PH, Steiner HH. Collision tumor composed of meningioma and cavernoma. J Korean Neurosurg Soc 2017; 60 (01) 102-107
  • 45 Ma L, Zhang S, Li Z. et al. Morbidity after symptomatic hemorrhage of cerebral cavernous malformation: a nomogram approach to risk assessment. Stroke 2020; 51 (10) 2997-3006
  • 46 Dammann P, Wrede K, Jabbarli R. et al. Outcome after conservative management or surgical treatment for new-onset epilepsy in cerebral cavernous malformation. J Neurosurg 2017; 126 (04) 1303-1311
  • 47 Davies JM, Kim H, Lawton MT. Surgical treatment of cerebral cavernous malformations. J Neurosurg Sci 2015; 59 (03) 255-270
  • 48 Stapleton CJ, Barker II FG. Cranial cavernous malformations: natural history and treatment. Stroke 2018; 49 (04) 1029-1035
  • 49 Wen R, Shi Y, Gao Y. et al. The efficacy of Gamma Knife radiosurgery for cavernous malformations: a meta-analysis and review. World Neurosurg 2019; 123: 371-377
  • 50 Peker S, Kiliç T, Sengöz M, Pamir MN. Radiosurgical treatment of cavernous sinus cavernous haemangiomas. Acta Neurochir (Wien) 2004; 146 (04) 337-341 , discussion 340
  • 51 Kondziolka D, Lunsford LD, Flickinger JC, Kestle JR. Reduction of hemorrhage risk after stereotactic radiosurgery for cavernous malformations. J Neurosurg 1995; 83 (05) 825-831