I'm a member of the board of a non-profit group devoted to finding solutions to cerebral cavernous malformations (http://www.angiomaalliance.org). I'm a patient, not a medical professional.
In August 2001, I experienced a single bleed from a 7mm cavernous malformation in my medulla oblongata. MRI exhibits the classic hemosiderin ring signature. The malformation does not present itself to a pial surface. Fortunately, most of my focal neurological deficits resolved within a few months of the hemorrhage.
A few general questions about hemosiderin deposition in the brain due to exophytic cavernous malformation bleeding:
1) Is hemosiderin an irritant? If so, could it have a negative impact on the hypothalamus? (One of our "members" has hemosiderin deposited near this structure).
2) Do neurosurgeons ever remove hemosiderin from brain parenchyma?
3) If #2 is yes, how is it done? Would the stained tissue itself have to be removed or can hemosiderin be removed by other means, leaving the previously stained tissue intact?
4) If #2 is normally "no", are there ANY circumstances under which hemosiderin is removed during neurosurgery?
5) Does the body (via CSF) eventually remove all traces of hemosiderin? If so, what kind of time frame is involved (generally speaking)?
1.Can be. It is thought that the hemosiderin deposition associated with cavernous angiomas may play a role in triggering seizures. Theoretically, if the cavenous malformation and hemosiderin were located in or near the hypothalamus it's possible to cause hypothalamic dysfunction depending on its exact location with respect to the functional components of the hypothalamus.
2+3.Yes, when there is surgical resection of a cavernous angioma such as that seen in the temporal lobe for epilepsy surgery, they usually take out the hemosiderin with it (by cutting it out along with a very small normal margin of tissue around it)depending on what brain structures are involved.
5.Unfortunately not, hemosiderin tends to hang around as a marker of prior hemorrhage.
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