Giant infiltrative cavernous malformation: Clinical presentation, intervention, and genetic analysis: Case report

Michael T. Lawton, G. Edward Vates, Alfredo Quiñones-Hinojosa, William C. McDonald, Douglas A. Marchuk, William L. Young

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

OBJECTIVE AND IMPORTANCE: Cavernous malformations can present in children with a sporadic course of repeated hemorrhage and enlargement, but they are rarely aggressive, infiltrative, or multilobar. We present the case of a young boy with a complex cavernous malformation that evolved during the course of a decade to encompass the majority of his right cerebral hemisphere. CLINICAL PRESENTATION: A 16-month-old boy presented with seizures, and radiographic studies demonstrated a large cavernous malformation in his right frontal pole. During the next 10 years, his seizures became intractable, and he developed progressive left hand weakness and atrophy. His malformation infiltrated his entire right frontal lobe as well as portions of his right parietal lobe, temporal lobe, and deep gray matter structures. INTERVENTION: The patient underwent right hemicraniotomy and near total resection of the lesion. Pathological analysis revealed dilated, thin-walled vessels separated by small amounts of intervening astrogliotic brain consistent with cavernous malformation. The patient recovered to his baseline neurological condition and has had no seizure or hemorrhage since his operation. Genetic testing did not reveal mutations in either the CCM1 (KRIT1) or CCM2 (malcavernin) genes. CONCLUSION: This case may represent an atypical variant of cavernous malformation best termed giant infiltrative cavernous malformation. Despite its unusual size, multilobar location, and aggressive infiltration, it can be managed effectively with standard surgical resection.

Original languageEnglish (US)
Pages (from-to)979-980
Number of pages2
JournalNeurosurgery
Volume55
Issue number4
DOIs
StatePublished - Oct 1 2004

Keywords

  • Cavernoma
  • Cavernous angioma
  • Cavernous malformation
  • Giant
  • Pediatric
  • Seizure
  • Vascular malformation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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