Venous angioma coexisting with other types of cerebrovascular malformations
Tanaka, R.; Miyasaka, Y.; Yada, K.; Yagisita, S.
No Shinkei Geka. Neurological Surgery 22(7): 665-669
1994
ISSN/ISBN: 0301-2603 PMID: 8078600 Document Number: 438311
The authors report 3 cases in which, in addition to venous angioma, other types of vascular malformations coexisted. They discussed the pathological significance of this coexistence, and the treatment to be given in these conditions. Case 1 : A 38-year-old man was admitted to the hospital because of progressive headaches of 3 days' duration. X-ray CT revealed a large hematoma in the left cerebellar hemisphere. Vertebral angiogram showed a caput medusae in the venous phase, which is a typical picture of venous angioma. The hematoma was surgically removed and careful inspection of the cavity wall was made. A thick vein and many thin walled dilated venules draining to the vein were observed in the cavity wall. These abnormal vessels were completely removed. Because of reaccumulation of the hematoma and massive edema of the hemisphere, reoperation was performed. On removing a part of the cerebellar hemisphere, a small mass of vascular network was found and removed together with the hematoma. Histologically, the first specimen was a typical venous angioma, and the second one was a arteriovenous malformation. Case 2: A girl 9 years of age was admitted because of headache and left sided ataxia. CT and MRI revealed a multi staged hematoma in the left cerebellar hemisphere. Vertebral angiography, however, failed to demonstrate any kind of vascular malformations. The hematoma was removed with its wall. The histological appearance was compatible with venous angioma. 4 years later she bled again, and reoperation was performed. Histological examination this time revealed a cavernous angioma. Case 3: A woman aged 21 years was admitted with intractable convulsive seizures which had continued for 2 years. CT revealed a small calcified lesion in the right frontal lobe. There was no enhanced lesion in the surrounding area. Angiogram failed to demonstrate any kind of vascular malformation. Histological examination revealed a cavernous angioma. The second operation was performed because of residue of the lesion found by postoperative CT. The residual area was removed, and histological appearance this time was that of capillary telangiectasia. 8 years later, she came back with intracerebral hemorrhage at the site of previous lesion. The hematoma with hematoma wall was removed. Histological examination revealed a venous angioma. Thus, in these 3 cases, in addition to venous angiomas, an AVM, a cavernous angioma, and both a cavernous angioma and capillary telangiectasia were also found. However, venous angioma and cavernous angioma are difficult to differentiate, and there are cases in which the histological picture is intermediate between the typical characteristics of the two, making differentiation so hard that the only identification that can be made is that it is some sort of venous cerebrovascular malformation.