[Cerebral cavernomas--clinical aspects and therapy].

Cavernomas are congenital cerebrovascular hamartomas which occur sporadic or familial. They are comprised of multiple sinusoidal spaces, filled with blood, without enlarged arterial feeders and draining veins. They occur in an estimated 0.4 to 0.5% of the population, with male and female patients equally affected and all ages represented. Lesions are singular or multiple (up to 20%) in the same patient and occur all over the central nervous system. Clinical representation is characterized by cross intracranial hemorrhage, seizures and focal neurological deficits. Unspecific symptoms, like headaches, vertigo and tinnitus were present in 25 to 30% of the patients. Asymptomatic cavernomas could be detected in up to 20% of the cases. The natural course revealed an annual risk of bleeding (0.6%) and a risk of developing epilepsy (1.5%). Microsurgical resection of a symptomatic lesion is the first choice of treatment. There is no mortality and the morbidity after resection of superficial cavernomas is below 5%. Deep seated cavernomas revealed a higher risk of postoperative neurological deficit. Therefore indication of operative removal in deep seated cavernomas should be carefully weighted up to the risk of natural course and generally neurological and radiological control is favoured. Radiosurgery is only indicated in progressively symptomatic cases which are surgical inaccessible.