gms | German Medical Science

Objective: Cerebral cavernous malformations (CCMs) are associated with intra- and extralesional hemorrhage and may become symptomatic with focal neurological symptoms (FND) or seizures in affected patients. To assess CCM characteristics accompanying symptomatic or asymptomatic single sporadic lesions, an observational single center study was conducted.

Method: A consecutive series of 260 patients with symptomatic (FND, seizures, headache or acute hydrocephalus) or asymptomatic CCMs treated or followed-up in our department were included for study purposes. CCM size, localization, size of hemorrhage, associated developmental venous anomaly (DVA), eloquent localization, surrounding edema and Zabramski classification were obtained from records and available MRI scans. Statistical analysis (chi square test, Mann-Whitney-U-Test, Fisher´s exact test) was done with SPSS.

Results: Our study included 150 female (57.7%) and 110 male (42.3%) patients with a mean age of 46,6 years (Range 9 - 80). Symptomatic (sl) (n=196) and asymptomatic (n=64) lesions (asl) showed no significant difference regarding sex (p=0.082) or age (p=0.383). CCM size was positively correlated with symptoms (mean sl=17.3 mm; mean asl= 10.1 mm; p<0.001). Only four asymptomatic CCMs showed an expansion of hemorrhage larger than 0.5 cm (p <0.001). Perifocal edema was more likely detected in symptomatic lesions (sl=39.6%; asl=6.8%; p<0.001). Extralesional hemorrhage was found in only one asymptomatic case. (sl=27.7%; asl=1.7%; p<0,001). Congruent to these findings most asymptomatic CCMs were Zabramski classification 2 (p< 0.001). Lesion localization to eloquent areas (sl=59.2%; asl=37.1) caused symptoms (p=0.003) more often. 103 patients (39.6%) had a concomitant DVA whereas this showed no impact on symptoms (p=0.449). The presence of seizures was highly associated with a cortical location of the CCM (96.3%).

Conclusions: In our study, CCM and hemorrhage size, perifocal edema and eloquent localization were MRI features commonly associated with clinical symptoms. Extra-lesional hemorrhage was almost always found in symptomatic CCMs. Overall, our data may be taken into account for the indication of surgery, especially if the correlation of symptoms with the CCM is unclear.