J Cerebrovasc Endovasc Neurosurg.  2013 Sep;15(3):255-259. 10.7461/jcen.2013.15.3.255.

Giant Cystic Cerebral Cavernous Malformation with Multiple Calcification: Case Report

• Kim IC
• Kwon KY
• Rhee JJ
• Lee JW
• Hur JW
• Lee HK

• KMID: 1491449
• DOI: http://doi.org/10.7461/jcen.2013.15.3.255

Abstract

Cerebral cavernous malformation with giant cysts is rare and literature descriptions of its clinical features are few. In this case study, the authors describe the clinical symptoms, radiological findings, and pathological diagnosis of cerebral cavernous malformations with giant cysts, reviewing the relevant literature to clearly differentiate this from other disease entities. The authors present a case of a 19-year-old male with a giant cystic cavernous malformation, who was referred to the division of neurosurgery due to right sided motor weakness (grade II/II). Imaging revealed a large homogenous cystic mass, 7.2x4.6x6 cm in size, in the left fronto-parietal lobe and basal ganglia. The mass had an intra-cystic lesion, abutting the basal portion of the mass. The initial diagnosis considered this mass a glioma or infection. A left frontal craniotomy was performed, followed by a transcortical approach to resect the mass. Total removal was accomplished without post-operative complications. An open biopsy and a histopathological exam diagnosed the mass as a giant cystic cavernous malformation. Imaging appearances of giant cavernous malformations may vary. The clinical features, radiological features, and management of giant cavernous malformations are described based on pertinent literature review.

Keyword

Cavernous malformation; Giant cyst

MeSH Terms

Basal Ganglia
Biopsy
Caves
Craniotomy
Glioma
Hemangioma, Cavernous, Central Nervous System
Humans
Male
Neurosurgery
Young Adult

Figure

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  Fig. 1 Preoperative imaging (A) Non-enhanced computed tomography scan shows a homogenous large-cystic lesion of 7.2×4.6×6 cm size in the left fronto-parietal lobe and basal ganglia. Note that there are mutliple parenchymal calcifications in both parietal lobes. (B) T1-weighted axial magnetic resonance imaging shows a large fronto-parietal hyperintense cystic lesion with local mass effect and minimal surrounding edema. (C) T2-weighted axial magnetic resonance imaging shows a heterogeneous high intra-cystic nodule, exhibited with hypodensities, suggestive of calcification. (D) T1-weighted contrast-enhanced coronal image reveals heterogeneous, slight enhancement of intra-cystic nodule, and a lack of enhancement of the cystic component.

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  Fig. 2 Low-power photomicrographs show thromboses within the cavernous vascular spaces. Also note thin-walled vascular channels without neural tissue (Hematoxylin & Eosin, ×100).

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  Fig. 3 Postoperative computed tomography image shows no residual cavernous malformations with intact multiple calcifications.

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