Neurocirugía Neurocirugía
Neurocirugia 1995;6:138-45 - Vol. 6 Núm.2 DOI: 10.1016/S1130-1473(95)70795-3
Tratamiento en los angiomas cavernosos
A. Isla, F. Alvarez, J. Muñoz, J. Nos, M. García-Blázquez
Servicios de Neurocirugía y Neurorradiología, Hospital «La Paz». Madrid
Resumen

Los angiomas cavernosos pueden pasar desapercibidos clínicamente. El tratamiento de estas malformaciones está sujeto a controversia, ya que la evolución de su historia natural, comparada con la de los angiomas arteriovenosos, presenta características más benignas. Hemos estudiado 55 angiomas cavernosos encontrados en 32 pacientes, con una edad media de 37 años. En 26 pacientes la localización fue única y 6 pacientes presentaron múltiples lesiones. Clínicamente la sintomatología dominante fue: epilepsía en 14 pacientes (43.7%); hemorragia en 11 (34.3%); cefaleas 11 (34.3%); Ydéficit motor en 10 (31.2%). El diagnóstico neurorradiológico fue practicado en 4 casos con la angiografía; TAC y angiografía se practicaron en 7 casos; TAC, RM y angiografía en 14 casos y en 7 casos TAC y RM. El tratamiento realizado fue quirúrgico en 23 casos y conservador en 9 casos.

El resultado de los 23 pacientes intervenidos fue bueno en 17 (73%); regular en 5 (22%); Ymalo en un paciente, por hemorragia masiva (4%). De los 9 pacientes no intervenidos, la evolución fue desfavorable en sólo uno, el cual había sido tratado con radiocirugía. La historia natural de los 55 angiomas cavernosos, correspondiente a los 32 pacientes, con un seguimiento de 5.3 años de media, ha mostrado un 1% de sangrado al año (dos pacientes no operados sangraron y otro sangró varios meses después de una extirpación parcial). Se concluye que la intervención quirúrgica de estas lesiones está indicada si sangran y su localización no supone aumentar el riesgo de morbilidad con la cirugía, o cuando se presentan con epilepsía refractaria al tratamiento médico.

Summary

Cavernous angiomas can be clinicalIy silent, and since their natural course is usualIy benign, treatment is quite controversial. A group of 32 patients with 55 cavernous angiomas and a mean age of 37 years is presented. Only 6 of these patients presented cavernous angiomas with multiple locations and single cavernous angiomas were seen in 26 patients. The patients presented with epilepsy in 14 cases (43.7%); hemorrhage in 11 (34.3%); headaches in 11 (34.3%); and motor deficit in 10 (31.2%). Neuroradiological studies included angiography in 4 cases, angiography plus CT in 7 cases, angiography plus CT and MR in 14 cases, and CT plus MR in 7 cases. Of the 32 patients, 23 were operated and 9 were managed conservatively. The outcome of surgery in the 23 operated patients was good in 17 (73%), fair in 5 (22%) and poor in one patient who had a massive hemorrhage. Only one of the unoperated patients did poorly and he was the only one who had received radiosurgery.

These 32 patients with 55 cavernous angiomas were folIowed during an average period of 5.3 years. The annual incidence of bleeding was 1% (two non operated patients bled and one patient bled several months after partial removal).

We concluded that surgery is indicated when the cavernous angiomas cause hemorrhage or refractory epilepsy, provided that they are in a favourable location.

Palabras clave
Angioma cavernoso, Malformaciones arteriovenosas ocultas, Resonancia Magnética
Key words
Cavernous angioma, Occult arteriovenous malformations, Magnetic Resonance Imaging
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Isla, A.; Alvarez, F.; Muñoz, J.; Nos, J.; García-Blázquez, M.: Tratamiento en los angiomas cavernosos. Neurocirugía 1995; 6: 138–145.

Copyright © 1995. Sociedad Española de Neurocirugía
Neurocirugia 1995;6:138-45 - Vol. 6 Núm.2 DOI: 10.1016/S1130-1473(95)70795-3