What does cavernous angioma mean?Cavernous Angioma is an abnormality of the blood vessels, marked by adjacent and large capillaries – blood flow is slow through these vessels. Cavernous Angiomas are also known as cavernoma, cerebral cavernous malformation, and cavernous hemangioma. A lesion occurs due to widened blood vessels – occurring in any part of the nervous system, mainly the central nervous system. Picture Courtesy: Cleveland In Cavernous hemangiomas, cells and blood vessels fail to form a passage, leading to leakage into the tissues as support from the muscles is hampered. This, in turn, causes haemorrhage – blood leaking from the capillaries, which results in visible symptoms. – Cavernomas are non-cancerous. Picture Courtesy: Angioma.org
What are the diagnostic steps for cavernous angiomas?Picture Courtesy: Mayoclinic The primary diagnosis involves an MRI – it shows a fine image of all the haemorrhages which are otherwise not visible on regular cerebral angiography. The radiographic impression is generally interpreted as the shape of mulberry or popcorn. Angiography is usually insignificant – it is used for a second opinion in the diagnosis procedure. CT scan is not a regular technique for the diagnosis of Cavernous Angiomas. For descriptive microscopic observation, the tissue is incised for biopsy. But these processes are hardly used as MRI is sufficient for proper diagnosis. After MRI, ultrasound is utilized for detecting liver cavernous angiomas.
How are cavernous hemangiomas treated?Treatment is based on some observations like internal bleeding. It is found that cavernous angiomas bleed occasionally. If it bleeds gradually, there is a chance for the blood to get reabsorbed, but if it bleeds rapidly, the chances of haemorrhage are prevalent. The risk of surgery varies on the position of the cavernoma – if present on the brain stem, in the cerebral cortex, the outer layer of the brain which controls speech, visual and motor activity, or on the spinal cord – then treatment is risky. Bleeding in these areas can cause more damage. So, the treatment plan is decided by comparing the risk and benefit factors. The doctor observes the symptoms and provides mild medications for improvement. If medication fails to improve the conditions, then surgery is required.
What is craniotomy surgery?This surgery is performed by removing the upper layer from the skull to examine the brain for cavernous angiomas. Craniotomy surgery is usually performed on patients suffering from traumatic or severe brain injury and brain lesions. Craniotomy also cures cerebellar tumors and Parkinson’s disease. Trepanation and craniectomy are different from craniotomy surgery. This procedure has a wide range of applications – it is also performed in the removal of tissue and in neuroscience for examining the brain. Picture Courtesy: Scielo The surgery is performed by administering anesthesia to the patients – MRI is done before the surgery to find the exact treatment spot. Then an incision is made at an angle for the appropriate area to be examined. After completing the surgery, a wire is used as a form of fixation of the area. The process is not painful though mild discomfort may occur.
How much time is required for Craniotomy surgery recovery?Recovery from surgery may take one to four weeks – sometimes, it can take seven to eight weeks. The patient has to stay for 7-10 days in the hospital for restoration. It is recommended to wash hair gently after surgery. Please do not use a comb on the operated area as it can be painful. Instead of using a hairdryer, use a towel to soak the water and avoid scrubbing the head. Also, most importantly, do not use color or dye in the hair for a few weeks and gradually get back to the daily routine.
What are the advantages of Craniotomy surgery?The advantages are it helps in reducing blood flow in the brain, restores membrane health and other tissues, and helps in removing blood clots. It also helps in reducing brain tumors and their sizes as well.
What are the disadvantages of craniotomy surgery?Significant swelling in the area, mild pain, and headaches for some time.
What are the most common symptoms associated with cavernous angioma?
Some of these lesions do not show any symptoms – although some common symptoms are:
- seizures and mass effect, which leads to vision disturbance
- language problems
- double vision
- internal bleeding
- memory loss
- hydrocephalus and numbing.
It often leads to blindness (full or partial). In less severe cases, symptoms are mild and often neglected but can be life-threatening. A person can experience pain in the abdomen, vomiting, dizziness, and loss of appetite.
What are the most common causes of cavernous angioma?
No particular cause was identified for Cavernous hemangiomas, although it can be due to genetic causes. A study points out that a few deletions of certain genes can lead to cavernous Angiomas – these genes are CCM1, CCM2, and CCM3, also known as KRIT1, malcavernin, or MGC4607, and PDCD10, respectively.
Secondly, the reduction of heterozygosity is a common cause of this problem. It signifies that single alleles mutation is required for abnormal cell multiplication. KRIT1 acts as a transcription factor to develop the blood vessels. On the other hand, CCM2 acts as the scaffolding protein, which coincides in configuration with CCM1. Although the function of CCM3 is vague, it is considered to have a similar representation as that of CCM1 and CCM2.
Radiation treatment can also cause Cavernous hemangiomas in a few patients. They result from the enhancement of the tissues due to abnormal division of cells or the abrupt multiplication of pericytic hyperplasia and cells.
What is the time duration for the surgery of the cavernous angiomas?
The surgery may last for 5 to 6 hours, depending on the problem and health conditions of the patient. After surgery, a few weeks of rest are necessary for recovery and faster improvement.
How should patients prepare for the treatment of Cavernous Angiomas?
The patients should thoroughly clean themselves, should not consume any liquid or food before surgery for at least 10-12 hours, should shave the area to be operated on, and one person should accompany the patient for post-surgical care. The patient should be well prepared to stay in the hospital as per the doctor’s advice.
What are the side effects or complications of the treatment?
The side-effects of the craniotomy surgery are the damage to the facial nerve, a scar in the head, a dent at the place, swelling in the brain for some time, sinus infection, infection of the skin, leakage of fluid from the incision, seizures, stroke and weakness of muscles.
What is the cost of the treatment of Cavernous Angiomas?
Craniotomy surgery is designed to treat cavernous angiomas. It is an expensive surgery. The lower cost approximately ranges between $20,703 to $33,655. In some countries, the cost is between $50,000 and $150,000. The cost may rise significantly in some other developed countries.
Can the condition be cured?
Yes, it can be cured. In earlier stages, mild medication and injections to manage the condition and judge the severity. If further treatment is required, surgery is done to remove it completely.
Are cerebral cavernous angiomas hereditary?
About 20% of the cases are hereditary (genetic). They are caused by a mutation in any one of three genes. If a parent is diagnosed with cavernous angioma, then their children’s chances of having it are about 50%.
Can a person have more than one cerebral cavernous hemangioma?
Yes, it is possible to have more than one cerebral cavernous hemangioma.
How common are cavernous angiomas?
Cavernous angiomas can affect about 1 in 200 people. It affects most commonly the age group between 20 and 30 years. Most of the patients are asymptomatic (no symptoms). Only 1 in 10 people will develop symptoms.
Can cerebral cavernous malformations be prevented?
In most cases, cavernous angiomas are silent, and no symptoms can be seen. Hence one cannot prevent it. However, a person can control the risk factors to decrease the chances of hemorrhage. They include:
- Maintain blood pressure- < 120/80mmhg.
- Total cholesterol levels < 200mg/dl
- Blood glucose levels <140mg/dl (2hrs after eating) and <99mg/dl (before eating).
Are cavernous malformations life-threatening?
Cavernous hemangiomas can be life-threatening if the patient is left untreated. The factors which can determine if the cavernous hemangiomas are life-threatening are listed below:
- Based on the size of the hemangiomas.
- The number of hemangiomas present.
- Location of the hemangiomas such as the brainstem, brain, or spinal cord.
- The likelihood that the lesion will rupture with severe bleeding.
What are other locations where cavernous angiomas can be formed?
Cavernous angiomas can occur anywhere in our body, such as the liver, skin, eye, etc.