AN UNUSUAL CASE OF CEREBELLAR VENOUS ANGIOMA ASSOCIATED WITH TEMPORAL CAVERNOMA – PATHOPHYSIOLOGICAL, DIAGNOSTIC, AND SURGICAL CONSIDERATIONS

Tabita Larisa Cazac1, Ioana Andreea. Dărămuș1, B.C. Dumitrescu2, V. Ciubotaru2, Ligia Gabriela Tătăranu1,2


1"Carol Davila" University of Medicine and Pharmacy  
2"Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania

Corresponding author: Tabita Larisa Cazac
Phone no.  0040766323590
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Abstract

 

Cerebral vascular malformations are hamartomas, classified into four distinct groups: arteriovenous malformations, cavernous malformations, capillary telangiectasias, and developmental venous anomalies. These abnormal vascular entities have distinct histopathological, radiological, and clinical features, which make them different from one another. We report a case of a 37-year-old man, who presented with headaches, generalized grand mal seizures, and an episode of loss of consciousness, due to a left temporal cavernoma. Gadolinium-enhanced T1-weighted MR images showed a left temporal “popcorn-like” lesion, with heterogeneous enhancement, measuring 15/17/18 mm, suggestive of a cavernoma (angiographically occult malformation). The T2-weighted MRI showed a right cerebellar venous plexus, draining into a larger central vein and the angiogram revealed the pathognomonic caput medusae aspect of a venous angioma. Microsurgical resection of the left temporal cavernous malformation was performed using a left frontal temporal approach. The venous angioma was spared to avoid venous infarction and cerebral edema with devastating vital consequences. The intra- and postoperative courses were uneventful with total recovery. The seizures remitted under anticonvulsant therapy, and the postoperative computer tomography investigation were within normal limits. The venous angioma was situated in the right cerebellar hemisphere, rather than near the cavernoma, its location making this the particular aspect of this case.

Keywordscerebellar venous angioma, temporal cavernoma, anticonvulsant therapy

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