Cavernous hemangioma

The cavernoma (Latin hemangioma cavernosum ) is a hemangioma, which is a vascular malformation, and can in principle occur in all tissues. Clinical relevance primarily cavernomas of the central nervous system, ie the brain and spinal cord. In the English literature, the terms cavernous angioma, cerebral cavernous malformation (CCM ), cavernous haemangioma, and cavernoma used interchangeably.

Frequency

Epidemiological data on the incidence of cavernomas in the general population are not available. At autopsy (mostly asymptomatic ) cavernomas of the central nervous system detectable in approximately 0.3-1 % of cases. Cavernomas are not infrequently found as a chance find, for example, in the context of magnetic resonance imaging.

Symptoms

Cavernomas may be visible by epileptic seizures or neurological signs ( seizures, paralysis, sensory disturbances, etc.). Most important complication is cerebral hemorrhage. For the propensity for bleeding, there are no reliable data. The estimates differ, depending on the size of the lesion, 0.5% to 10 % per year.

Pathology

Histologically, cavernomas from medium-to large-bore pathological blood vessels whose walls appear thin fibrotic often eccentric. In contrast to arteriovenous malformations neither an arterial nor venous differentiation is detectable in cavernomas. In the surrounding area there are often deposits of blood degradation products ( hemosiderin ) as an indication of older hemorrhage.

Genetics

Most cavernomas occur sporadically without an identifiable genetic disorder is present. Rarely is a familial occurrence. For those concerned ( which often multiple cavernomas occur ) could, among other mutations of the genes CCM1, CCM2 or CCM3 be detected.

Treatment

Especially after hemorrhage or otherwise uncontrollable epileptic seizures Cavernomas be removed by surgery. The indication for surgery is made rather cautious in asymptomatic incidental findings.