ABSTRACT
PURPOSE: Intraventricular cavernomas are rare. Even more rare are those presenting in the trigone of the lateral ventricles. METHODS: We performed a search of the literature of the last 30 years and identified all cases of intraventricular cavernous angiomas. Trigonal cavernomas were separately identified and analysed. Our search yielded a total of 13 trigonal cavernomas. RESULTS: Of a total of 61 intraventricular cases, 13 were located in the trigone of the lateral ventricles. The most prominent presenting symptom was intracranial hypertension (68.9%), followed by seizures (18.2%) and hemorrhage (13.1%).The literature review revealed a trend of intraventricular cavernomas to present with intracranial hypertension rather than seizures or focal neurologic deficit, unlike their intraparenchymal counterparts. We feel that this difference has received little attention in the international literature. We discuss a possible pathogenetic mechanism for the presence of intracranial hypertension and address different aspects of diagnosis and treatment of this benign lesion. CONCLUSIONS: Trigonal cavernomas are benign lesions that have an excellent outcome after radical excision. Symptoms and signs of intracranial hypertension and hydrocephalus may be the prominent initial presentation of this rare ailment.
Subject(s)
Cerebral Ventricle Neoplasms/pathology , Cerebral Ventricle Neoplasms/physiopathology , Hemangioma, Cavernous, Central Nervous System/pathology , Hemangioma, Cavernous, Central Nervous System/physiopathology , Lateral Ventricles/pathology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/physiopathology , Cerebral Ventricle Neoplasms/surgery , Diagnosis, Differential , Female , Hemangioma, Cavernous, Central Nervous System/surgery , Humans , Hydrocephalus/etiology , Hydrocephalus/physiopathology , Intracranial Hypertension/etiology , Intracranial Hypertension/physiopathology , Lateral Ventricles/surgery , Magnetic Resonance Imaging , Middle Aged , Neurosurgical Procedures , Papilledema/etiology , Papilledema/physiopathology , Seizures/etiology , Seizures/physiopathology , Treatment OutcomeABSTRACT
The majority of hemorrhagic arachnoid cysts are correlated with trauma or aneurysmal rupture. We report on a 35-year-old woman with acute headache and an intracranial mass lesion that was hyperdense in CT and hyperintense in conventional MRI images. The history and imaging were negative for trauma or vascular anomaly. Diffusion-weighted imaging (DWI) clearly demonstrated a large right anterior and middle cranial fossa arachnoid cyst with associated subacute intracystic hemorrhage without subdural hematoma. DWI offers invaluable information for the differential diagnosis of hemorrhagic arachnoid cysts from other extra-axial space-occupying lesions.