title: Cerebral capillary telangiectasias: a meta-analysis and review of the literature.
abstract: As a result of their presumed benign natural history, cerebral capillary telangiectasias (CCTs) are infrequently addressed in the neurosurgical literature. We performed a comprehensive review of CCTs via the PubMed database to synthesize overall epidemiological, radiographic, natural history, and treatment results. Across ten series with 203 patients, mean age was 47, and 45 % were male [95 % confidence interval (CI), 0.30-0.65]. Notably, 78 % of CCTs were in the pons (95 % CI, 0.58-1.0). Six percent of CCTs were symptomatic. Across five radiographic series, all lesions enhanced after gadolinium, and all were hypointense on gradient echo sequences. Thirty-three percent were hypointense on T1-weighted pre-contrast imaging (95 % CI, 0.2-0.51), 49 % were hyperintense on T2-weighted imaging (95 % CI, 0.31-0.72), and 74 % were hypointense on diffusion-weighted imaging (95 % CI, 0.5-1.0). Notably, 37 % were associated with a prominent draining vein (95 % CI, 0.21-0.6), and 11 % with a developmental venous anomaly (95 % CI, 0.04-0.25). Across four observational studies with 47 patients, there was no observed change in lesion morphology or hemorrhage in 65.7 patient-years of follow-up. Although the vast majority of CCTs are managed conservatively, we found ten cases of patients treated with surgical excision. We confirm that CCTs are a benevolent entity with a predilection for the pons. They have distinctive radiographic features including their lack of mass effect, consistent enhancement on T1-weighted sequences and hypointensity on gradient echo sequences, and common isointensity on pre-contrast T1-weighted and T2-weighted images. Management for these lesions has been nonoperative in almost all cases.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.forename: A John
authors.initials: AJ
authors.lastname: Popp
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000328:Adult; D002196:Capillaries / Q000473:pathology; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D013684:Telangiectasis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*