THE ECHO-GUIDED REMOVAL OF CEREBRAL CAVERNOUS ANGIOMAS

Twenty cavernous angiomas were surgically removed after being localise d by intra-operative echography. 10 patients were males and 10 females , with an average age of 34 years. Four patients had had intracerebral haemorrhage; all the remaining patients presented with headaches or s eizures. The size of the lesion ranged from a minimum of 2.5 to a maxi mum of 4.0 cm. Its localisation was subcortical in 14 cases, paraventr icular in 4 and in another 2 originated from the floor of the IV ventr icle. Echography showed a blackberry-like cavernous angioma, hyperecho genous with respect to the surrounding parenchyma; the lesion was well -defined in all cases due to the absence of perilesional oedema with a clear demarcation from healthy tissue. After operation, pre-operative cranial nerve deficits (brought on by haemorrhage) only persisted in the two cases where the cavernoma involved the floor of the IV ventric le. In all cases post-operative radiological investigation recorded th e complete removal of the cavernous angioma, the diagnosis of which wa s invariably confirmed by histological analysis. The authors draw the conclusion that intra-operative echography is capable of localising ca vernous angiomas, providing the surgeon with real-time guidance during microsurgical removal. It is also useful for establishing as to wheth er complete removal has been accomplished.