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Neurosurgical management of cavernous malformations located at the foramen of Monro

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Abstract

Cavernous malformations (CMs) located at the foramen of Monro (FM) are relatively rare benign vascular malformations. Knowledge of FM CM is poor. The aims of this study were to describe the incidence, clinical presentation, radiological features, surgical approaches, and neurological outcomes for FM CM patients and to discuss the treatment strategy for this disease. We present a series of nine FM CM patients (four males, five females; mean age 29.3 years) who were treated at a single neurosurgical center. FM CM accounted for 0.56% of the entire series of the central nervous system (CNS) CMs. Headache accompanied by nausea and vomiting was the most common initial symptom (55.6%). The mean preoperative Karnofsky Performance Scale (KPS) score was 84.4 (range 70–100). In all but one patient, the lesions were surgically resected. Postoperatively, two patients developed obstructive hydrocephalus, and one experienced motor aphasia and right hemiparesis. At the time of discharge, the KPS score improved to a mean of 88.9. Follow-up period after diagnosis was 18 to 131 months (mean 69.7 months); all the patients were considered to be in excellent clinical condition. FM CMs are rare and challenging lesions; they have a female predilection. The most common clinical manifestations of FM CM are the symptoms of mass effect. The seizure risk of FM CMs seems to be significantly lower than that of general intraventricular CMs. Early surgical intervention should be offered to symptomatic cases, and gross total resection is associated with favorable neurological outcomes.

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Funding

This study was funded by the National Natural Science Foundation of China (81371292) and the “13th Five-Year Plan” National Science and Technology supporting plan (2015BAI12B04).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, People’s Republic of China

    Chengjun Wang, Meng Zhao, Xiaofeng Deng, Jia Wang, Zhongli Jiang & Jizong Zhao

  2. China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China

    Chengjun Wang, Meng Zhao, Xiaofeng Deng, Jia Wang, Zhongli Jiang & Jizong Zhao

  3. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China

    Chengjun Wang, Meng Zhao, Xiaofeng Deng, Jia Wang, Zhongli Jiang & Jizong Zhao

  4. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People’s Republic of China

    Chengjun Wang, Meng Zhao, Xiaofeng Deng, Jia Wang, Zhongli Jiang & Jizong Zhao

  5. Department of Pathology, The General Hospital of Chinese People’s Armed Police Forces, Beijing, People’s Republic of China

    Qingming Shu

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  1. Chengjun Wang
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Correspondence to Jizong Zhao.

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This study was approved by the Research Ethics Board of Beijing Tiantan Hospital, Capital Medical University.

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Informed consent was obtained from all individual participants who were included in the study.

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Wang, C., Zhao, M., Deng, X. et al. Neurosurgical management of cavernous malformations located at the foramen of Monro. Neurosurg Rev 41, 799–811 (2018). https://doi.org/10.1007/s10143-017-0930-0

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