Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Cerebral Cavernous Hemangioma
Forum: The Neurology and Neurosurgery Forum
Topic Area: Neurosurgery - General
Posted by CCF Neurosurgery MD/gm on May 11, 1998 at 20:28:48:
In Reply to: Cerebral Cavernous Hemangioma posted by Jana on May 11, 1998 at 13:09:51:



THANKS to this wonderful forum, a neurosurgeon responded to a question regarding my recently diagnosed cavernous hemangioma. The lesion is approximately 3.8 x 2 cm, is close to my speech and language area, has a dark ring around it on MRI, and extends from the cortical area down to the ventricle. Its size and shape a bit atypical, so there is a possibility that it is two contiguous lesions. The neurosurgeon who responded to the question I posted said that these lesions are typically excised if they are quite accessible. Could you also tell me:
* Do all cavernous hemangiomas have the dark ring around them on MRI? Or does that definitely signal true "hemorrhage?"
* What is the true hemorrhage rate? I've heard various statistics about the risk rates of hemorrhage. One study says that the risk is .25 to .7 percent each year, while others say more or less. I also understand that the rehemorrhage risk is significantly higher.
* Are hemorrhages life-threatening? What typically happens as a result of a hemorrhage?
* Would you still recommend surgery in a patient that is likely asymptomatic? The reason I originally visited a neurosurgeon 2 months ago was because of very infrequent (6 total in 6 years) spells of severe vertigo--room spinning accompanied by nausea and vomiting, and two to three weeks of feeling "unbalanced." However, I've been told that, given its location, it's likely not related. The only other time I could have had symptoms of hemorrhage was 6 years ago when I had a HORRIBLE headache and neckache that lasted for about a week.

Any further insight you could provide would be much appeciated. Thanks again for your response!
--Jana

Dear Jana:

Thank you for your kind words. The risk of hemorrhage from AVM's is
between 2-4% per year. The risk of bleeding from cavernous angiomas is
less but there is a variation in the rates that are discussed. Not all
lesions have a dark ring around them and that usually signifies bleeding.
Bleeds can be life threatening or can cause significant neurological impairment.
I would still recommend surgery because it is the only definitive therapy and
it seems that you have already bled from this lesion once before so if
this is located in an accessible area and you trust your neurosurgeon then
you should have it taken out. You could also seek a second opinion.
Good Luck!

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