Cavernous Hemangioma

[Jana]

First of all, thanks again for this absolutely wonderful forum. I visited about two years ago seeking advice when I first learned I had a cavernous hemangioma. About 18 months ago, I had surgery to remove the 3 cm C.A. from my left frontal lobe. It had extended from the cortical area of the brain to the ventricle. I've had two follow up MRIs, and they've demonstrated that the entire mass was removed. In addition, there's no evidence of other C.A.s.

I have two questions:
1. I had some severe headaches in the days following surgery, but is it normal to continue to have lingering headaches that are confined to the surgical area? Sometimes they start with a sharp twinge and then a more mild headache lasts for several hours. Actually, I'm able to control them quite well with three Advil, if I catch it right away. But, am I right to assume that they are a normal consequence of surgery?

2. I have a five-year-old who sometimes complains of a headache in the same spot toward the back of his head. They are certainly not severe, because he has no problem continuing normal activities, and they don't happen often. Of course, being a rather neurotic parent, I worry that perhaps he could have a C.A. too. Any idea what the chances are? At what age should I consider having him tested--or shouldn't I?

Any advice you could offer would be much appreciated. THANK YOU for your time.

[CCF Neuro[P] MD, RPS]

Dear Jana:

I can't tell you how long the headaches will last. I think your neurosurgeon would be the best to ask.  Hopefully, they will begin to calm down and regress.  Sorry, I am not much help.  I do not know the extent of the surgery.

CCF Neuro MD

[Jana]

Thanks for your reply. I, too, believe the headaches are a result of surgery, because they are different than a "regular" all-over headache. The area of pain is contained to the surgical area. In your experience, how long after surgery do they last? They seem to be more frequent when I'm tired or stressed, which are situations that are difficult to avoid with a young family. As I said, they are not unmanagable, but certainly something I'm hoping will cease. Are they something I should be concerned about?

In regard to my son, I appreciate your feedback. I mentioned it to his pediatrician at his 5-year-old check-up, and she said she wasn't sure about the genetic possibilities but that she could authorize an MRI, if that's what I wanted. At such a young age, I would hate to put him through unecessary tests. It helps to know that he likely wouldn't present with symptoms until much later.

Thanks again for your advice.

[CCF Neuro[P] MD, RPS]

Dear Jana:

It is difficult to tell you for certain whether the headaches are the result of the surgery or not.  This is especially true since I have not talked to your neurosurgeon or seen the subsequent MRI films after surgery.  I would think that the answer is yes.  Many patient have had similar findings.  

There are some families that have a genetic inheritance of cavernous angiomas.  It is an autosomal dominant gene, and therefore 50% of your offspring may have one.  However, there are spontaneous forming cavernous angiomas also (not genetic).  Since the usual presentation is 20 to 30 years of age, I don't think I would push the testing as of yet.  We have seen youngsters with CA of the genetic type present early (8-10 yrs).  I would just follow your son at present.  However, if the headache changes in intensity or type, then I would image him.

Sincerely,

CCF Neuro MD