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Co-occurrence of a cerebral cavernous malformation and an orbital cavernous hemangioma in a patient with seizures and visual symptoms: Rare crossroads for vascular malformations.

Choudhri O, Feroze AH, Lad EM, Kim JW, Plowey ED, Karamchandani JR, Chang SD - Surg Neurol Int (2014)

Bottom Line: As a result of hemorrhage and mass effect, patients may present with focal neurologic deficits, seizures, and other symptoms necessitating treatment.We provide a brief overview of the two related pathologies in the context of a patient presenting to our care with concomitant lesions, which were both resected in full without complication.Recognition of disparate symptomatologies is important for properly managing these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, California, Canada.

ABSTRACT

Background: Cerebral cavernous malformations (CCMs) are angiographically occult vascular malformations of the central nervous system. As a result of hemorrhage and mass effect, patients may present with focal neurologic deficits, seizures, and other symptoms necessitating treatment. Once symptomatic, most often from hemorrhage, CCMs are treated with microsurgical resection. Orbital cavernous hemangiomas (OCHs) are similar but distinct vascular malformations that present within the orbital cavity. Even though CCMs and OCHs are both marked by dilated endothelial-lined vascular channels, they are infrequently seen in the same patient.

Case description: We provide a brief overview of the two related pathologies in the context of a patient presenting to our care with concomitant lesions, which were both resected in full without complication.

Conclusion: This is the first known report that describes a case of concomitant CCM and OCH and explores the origins of two pathologies that are rarely encountered together in neurosurgical practice. Recognition of disparate symptomatologies is important for properly managing these patients.

No MeSH data available.


Related in: MedlinePlus

Intraoperative images of the OCH resection. Pathology was resected utilizing an incision along the lid crease. An operative window was created with an extended lateral orbital bone flap
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Figure 2: Intraoperative images of the OCH resection. Pathology was resected utilizing an incision along the lid crease. An operative window was created with an extended lateral orbital bone flap

Mentions: Following induction of generalized anesthesia, the ophthalmology team made an incision at the upper lid crease and proceeded to dissect superiorly in the plane between the orbicularis muscle and orbital septum [Figure 2]. The superior and lateral orbital rims were then exposed and the periosteum was reflected off the bone. The previous osteotomy sites were identified and an inferior osteotomy was created at the previous surgical site (at the zygomatic arch) using an oscillating saw. A superior marginotomy was then created at the superior orbital rim, medial to the supraorbital notch. The oscillating saw and the craniotome were used to remove the extended bone flap in a single piece of bone. The cutting burr was employed to further conservatively thin the bone in the lateral orbital rim. The branch of the middle meningeal artery anterior to the superior orbital fissure was identified and cauterized. The subperiosteal dissection was continued to the orbital apex to expose the orbital mass in the superior orbit.


Co-occurrence of a cerebral cavernous malformation and an orbital cavernous hemangioma in a patient with seizures and visual symptoms: Rare crossroads for vascular malformations.

Choudhri O, Feroze AH, Lad EM, Kim JW, Plowey ED, Karamchandani JR, Chang SD - Surg Neurol Int (2014)

Intraoperative images of the OCH resection. Pathology was resected utilizing an incision along the lid crease. An operative window was created with an extended lateral orbital bone flap
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109172&req=5

Figure 2: Intraoperative images of the OCH resection. Pathology was resected utilizing an incision along the lid crease. An operative window was created with an extended lateral orbital bone flap
Mentions: Following induction of generalized anesthesia, the ophthalmology team made an incision at the upper lid crease and proceeded to dissect superiorly in the plane between the orbicularis muscle and orbital septum [Figure 2]. The superior and lateral orbital rims were then exposed and the periosteum was reflected off the bone. The previous osteotomy sites were identified and an inferior osteotomy was created at the previous surgical site (at the zygomatic arch) using an oscillating saw. A superior marginotomy was then created at the superior orbital rim, medial to the supraorbital notch. The oscillating saw and the craniotome were used to remove the extended bone flap in a single piece of bone. The cutting burr was employed to further conservatively thin the bone in the lateral orbital rim. The branch of the middle meningeal artery anterior to the superior orbital fissure was identified and cauterized. The subperiosteal dissection was continued to the orbital apex to expose the orbital mass in the superior orbit.

Bottom Line: As a result of hemorrhage and mass effect, patients may present with focal neurologic deficits, seizures, and other symptoms necessitating treatment.We provide a brief overview of the two related pathologies in the context of a patient presenting to our care with concomitant lesions, which were both resected in full without complication.Recognition of disparate symptomatologies is important for properly managing these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, California, Canada.

ABSTRACT

Background: Cerebral cavernous malformations (CCMs) are angiographically occult vascular malformations of the central nervous system. As a result of hemorrhage and mass effect, patients may present with focal neurologic deficits, seizures, and other symptoms necessitating treatment. Once symptomatic, most often from hemorrhage, CCMs are treated with microsurgical resection. Orbital cavernous hemangiomas (OCHs) are similar but distinct vascular malformations that present within the orbital cavity. Even though CCMs and OCHs are both marked by dilated endothelial-lined vascular channels, they are infrequently seen in the same patient.

Case description: We provide a brief overview of the two related pathologies in the context of a patient presenting to our care with concomitant lesions, which were both resected in full without complication.

Conclusion: This is the first known report that describes a case of concomitant CCM and OCH and explores the origins of two pathologies that are rarely encountered together in neurosurgical practice. Recognition of disparate symptomatologies is important for properly managing these patients.

No MeSH data available.


Related in: MedlinePlus