Intracranial cavernous angioma: a practical review of clinical and biological aspects.
BACKGROUND
Cavernomas are an uncommon lesion seen in neurosurgical practice that can occasionally rupture. Recent developments in neurosurgical technique and microbiology have brought greater insight into the treatment and molecular pathogenesis of cavernoma. In this review, a historical overview of cavernous angioma, a current paradigm for treatment, promising new molecular biological developments, and suggestions for future directions in neurosurgical research are presented, with emphasis on practical clinical applications.


METHODS
A survey of the literature on cavernous angioma and consultation with the Department of Neurosurgery at Northwestern Memorial Hospital was conducted by the authors to gain greater insight regarding this lesion. Papers and consultation revealed the importance of careful evaluation of this lesion, new techniques such as functional magnetic resonance imaging and frameless stereotaxy that simplify clinical management of cavernomas, and potential mechanisms by which to tackle this lesion in the future. New basic knowledge on disease biology is summarized with practical applications in the clinical arena.


RESULTS
There appear to be a number of controversies regarding management of this lesion. These include risk factors faced by the patient, controversy over the importance of resection, and modality through which the treatment should occur. An algorithm is presented to aid the neurosurgeon in management of these lesions.


CONCLUSIONS
Exciting developments in neurosurgery and molecular biology will continue to have a major impact on clinical treatment of this disease. Unresolved issues regarding the importance of certain risk factors, the role for radiotherapy in treatments, and the underlying molecular abnormalities must be tackled to gain greater clarity in treatment of this lesion.
Raychaudhuri
Ratul
R
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Batjer
H Huntington
HH
Awad
Issam A
IA
D000465:Algorithms; D015415:Biomarkers / Q000032:analysis; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D000075927:KRIT1 Protein; D008279:Magnetic Resonance Imaging; D008869:Microtubule-Associated Proteins / Q000032:analysis; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000032:analysis
D015415:Biomarkers; D000075927:KRIT1 Protein; C107928:KRIT1 protein, human; D008869:Microtubule-Associated Proteins; D011518:Proto-Oncogene Proteins