Neurochirurgie
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Intramedullary cavernomas are rare, but with routinely use of MRI detection has improved, raising the problem of choosing the adequate management approach: conservative or surgical. Cavernomas are vascular malformations, but, as hemangioblastomas they appear as vascular tumors of the spinal cord. They can be durably asymptomatic. ⋯ The lesion is often superficial, covered by the pia-mater, visible immediately after opening the dura, the approach is direct; but in few cases the cavernoma is deep seated in the spinal cord and not visible, the approach is through the midline. It is recommended to perform a complete "en bloc" resection. A yearly MRI control is necessary to search possible "de novo" cases.
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The aim of this study is to assess the efficiency of radiosurgery (RS) in the treatment of brain cavernomas. The series included intra-axial 17 lesions in 15 patients, 10 women and 5 men. Eleven were infratentorial lesions (brain stem and cerebellum) and 6 supratentorial (thalamus, hippocampus, brain cortex and paraventricular region). ⋯ Hemorrhage incidence observed after RS was 7.17% (significant with P<0.01, P<0.001). At the end of follow up, 12 patients were symptom-free, 2 had sequels from bleeding, 1 patient died. Radiosurgery is an efficient treatment of cavernomas leading to a total disappearance of 70% of the lesions and significantly reducing the risk of new hemorrhages.
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Review
[Role of radiosurgery in the management of intracranial cavernomas. Review of the literature].
From a review of the literature dealing with radiosurgery of cavernous malformations, we have analyzed its impact on hemorrhagic risk, epilepsy, histological modifications, morbidity and potential indications of treatment. Radiosurgery could significantly reduce the hemorrhagic risk, in a selected population with a high risk of hemorrhage, after an interval of about 2 years, but cannot provide protection against rebleeding. As for epilepsy related to the lesion, a significant reduction of seizures has been observed in certain cases, with better control in case of recent evolution and simple seizures linked to the site of the vascular malformation. ⋯ Radiosurgery can be proposed for non-surgical lesions with a high risk of hemorrhage, nevertheless the superiority of the technique over conservative treatment has to be proven. Without long-term prospective studies, the efficiency of RS for cavernomas remains questionable and subject to debate. New imaging methods proving the obstruction of the cavernous malformation are needed.