Possible Self-Healing of Cerebral Cavernomas

Case Report

Austin Neurosurg Open Access. 2016; 3(2): 1049.

Possible Self-Healing of Cerebral Cavernomas

Pozzati E*, Valluzzi A and Fioravanti A

Department of Neurosurgery, Bellaria Hospital, Bologna, Italy

*Corresponding author: Eugenio Pozzati, Department of Neurosurgery, Bellaria Hospital, Bologna, Italy

Received: July 27, 2016; Accepted: August 22, 2016; Published: August 24, 2016


The natural history of cerebral cavernous malformations, or cavernomas, is generally discussed in terms of progression including in particular the hemorrhagic course which constitutes the most important risk of the disease. Otherwise, long lasting regression and quiescence may occur, but the chance of a non-surgical cure has been never considered.

Cerebral cavernomas have been divided in four types on the basis of their histopathological features and Magnetic Resonance Imaging. Type I generally corresponds to a subacute hemorrhage surrounded by a ring of hemosiderin and gliotic parenchyma. We describe one case of durable clinical and radiological self-healing of a sporadic Type I cavernoma consisting of a residual ring of hemosiderin staining close to a small Developmental Venous Anomaly (DVA).

We believe that some cavernous malformation may vanish after hemorrhage through a short-circuit in their development at a very immature stage. The impact of a possible self-cure on the management of this malformation should be better evaluated in the future.

Keywords: Cavernous malformation; Development venous anomaly; Epilepsy; Healing; Hemorrhage; Magnetic resonance imaging


Cerebral Cavernomas or Cavernous Malformations (CMs) are hemorrhagic lesions consisting of clusters of endothelial sinusoidal channels, filled with blood in various stages of organization, intermingled with dense connective matrix and surrounded by hemosiderin stained gliotic parenchyma. These histopathological features configure a mature lesion and correlate with the four types of CMs classified on the basis of their Magnetic Resonance Imaging (MRI) findings [1]. They exist in two forms, familial and sporadic with different pathophysiology: most importantly, the sporadic form is very often associated to a Development Venous Anomaly (DVA). CMs are dynamic lesions growing and shrinking, rarely remaining quiescent and never self healing [2,3]. They may present with seizures, hemorrhage and focal deficits. In particular, the course of hemorrhage is unpredictable and the major risk is its recurrence: for this reason, surgical treatment is often considered. We report an apparent selfcure of an hemorrhagic cavernoma that arrested at Type I lesion and involuted leaving only its ring-shaped hemosiderin staining without residual malformation.

Case Report

In January 2010, this 40 year-old healthy man presented with a focal motor seizure involving the right arm. Computed tomography scan on admission showed a hypodense, roundish and well demarcated lesion in the left parietal region. T1 and T2 Weighted Images (WI) showed a subacute focus of hemorrhage surrounded by a hypointense rim of hemosiderin stained brain and cerebral swelling, consistent with a cavernous malformation. After contrast medium administration a small associated DVA was found (Figure 1). A surgical excision was planned, but the patient preferred to postpone the operation due to familial problems. In August 2010, MRI was repeated, but the lesion had disappeared leaving only a residual ring shaped hemosiderin deposition close to the DVA on Gradient Recalled Echo (GRE) sequences (Figure 2). The operation was not performed. Three years later the patient had a partial motor seizure: follow-up MRI confirmed the previous favourable findings and the electroencephalogram was normal. When seen in 2015, he remains well without antiepileptic medication.

Citation: Pozzati E, Valluzzi A and Fioravanti A. Possible Self-Healing of Cerebral Cavernomas. Austin Neurosurg Open Access. 2016; 3(2): 1049.