title: Cerebellar cavernous malformation in pediatric patients: defining clinical, neuroimaging, and therapeutic characteristics.
abstract: OBJECTIVE
  Cerebellar cavernous malformations (CCMs) have not been specifically described in the pediatric age group. Authors of this study, after considering the published literature, describe the characteristic clinical, radiological, and surgical features of CCM in children. METHOSDS: Patients younger than 18 years of age who were known to have CCM and had undergone surgery between 1992 and 2014 at the authors' institution were reviewed. Pediatric CCM cases reported in the literature (case reports and cases included in series on CMs in the pediatric age group) were also analyzed for specific features of this entity.
  
  
  RESULTS
  Four male patients and 1 female patient (2.5-14 years of age) with CCM presented acutely with severe headache followed by cerebellar dysfunction. In all patients, neuroimaging (cranial CT and MRI) demonstrated hemorrhagic cerebellar lesions with heterogeneous T1 and T2 signal intensities and hyperintense blooming on susceptibility-weighted imaging. The lesions reached large sizes exhibiting spherical, cystic, and often "pseudotumoral" morphology. In 3 patients, developmental venous anomalies (DVAs) were found. In 4 of the 5 patients, the CCMs and hematomas were totally removed. All patients had a clinically excellent functional outcome without surgical complication and with complete resolution of their presenting symptoms.
  
  
  CONCLUSIONS
  Cerebellar CMs occur in all pediatric age groups and display characteristic clinical and imaging features. In children, CCMs reach large sizes and can result in massive hemorrhage, often leading to a possible diagnosis of hemorrhage into a tumor. An associated DVA is quite common. Surgery is a safe and efficient treatment option with excellent outcomes in patients.
authors.affiliation: Division of Pediatric Neurosurgery, British Columbia Children's Hospital and Department of Surgery, University of British Columbia;|Department of Neurosurgery, University Hospital of Schleswig-Holstein Campus Kiel, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Knerlich-Lukoschus
authors.affiliation: Division of Pediatric Neurosurgery, British Columbia Children's Hospital and Department of Surgery, University of British Columbia;
authors.forename: Paul
authors.initials: P
authors.lastname: Steinbok
authors.affiliation: Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dunham
authors.affiliation: Division of Pediatric Neurosurgery, British Columbia Children's Hospital and Department of Surgery, University of British Columbia;
authors.forename: David Douglas
authors.initials: DD
authors.lastname: Cochrane
mesh_terms: D000293:Adolescent; D001259:Ataxia / Q000209:etiology; D001955:British Columbia; D002531:Cerebellum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004172:Diplopia / Q000209:etiology; D005260:Female; D006261:Headache / Q000209:etiology; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
keywords: BCCH = British Columbia Children’s Hospital; CCM = cerebellar cavernous malformation; CM = cavernous malformation; CN = cranial nerve; CTA = CT angiography; DVA = developmental venous anomaly; MRA = MR angiography; SWI = susceptibility-weighted imaging; cavernoma; cavernous malformation; cerebellum; neuroimaging; outcome; pediatric age group; surgical treatment; vascular disorders