GROWTH, SUBSEQUENT BLEEDING, AND DE-NOVO APPEARANCE OF CEREBRAL CAVERNOUS ANGIOMAS

IN A SERIES of 145 patients with brain cavernous angiomas treated at o ur hospital in the last 16 years, the angiomas of 18 patients exhibite d aggressive biological behavior characterized by recurrent overt blee ding, growth, or de novo appearance. The cavernomas were in the cerebe llum in three patients, in the brain stem in one, in the thalamus in f our, in the caudate nucleus in two, in the diencephalon in one, and in the white matter of the cerebral hemispheres in seven. Three of these patients suffered from the familial or multiple form of the disease, two were pregnant, three had previously been irradiated for other tumo rs, and one had been treated by radiosurgery in the past. Overall, new cavernous malformations not previously shown were discovered in six p atients. In 10 patients (3 male and 7 female) presenting with recurren t hemorrhages, the mean period of time between bleedings was 11 months (range, 1 wk-3 yr). Eleven patients were treated by definitive surger y, and seven were conservatively treated. One patient with a diencepha lic cavernoma died from progressive hypothalamic dysfunction; three pa tients in the nonsurgical group had repeated symptoms and were left wi th additional neurological deficits. The outcome of the surgical group was the same (seven patients) or improved (four patients). Risk facto rs favoring an aggressive behavior included pregnancy, familial or mul tiple form of the disease, previous whole brain or stereotactic radiot herapy, incomplete removal, brain location, and associated venous malf ormation. The female preponderance (female to male ratio, 13:5) may al so suggest some role of hormonal factors in influencing the biological behavior of cavernous malformations.