A case of urgent neurosurgical treatment of intracerebral hemorrhage due to rupture of a cavernous hemangioma because of the progressive clinical deterioration

Abstract

Cavernous hemangiomas (CH) are benign vascular lesions of the central nervous system, which are thin-walled vascular sinusoids without smooth muscle with hemosiderin deposits. CH is the second (after aneurysms) most frequent incidental vascular finding on magnetic resonance imaging of the brain, with a prevalence of 1 case per 625. CHs can be asymptomatic, cause seizures, intracranial hemorrhage due to rupture, or be the cause of focal neurological deficits without signs of previous hemorrhage. Intracranial hemorrhages of varying degrees of severity can occur both in supratentorial and infratentorial CH. The annual frequency of bleeding in CH is 0.3‒2.4 %, but they are rarely fatal, especially with supratentorial localization. Indications and timing of surgical intervention in CH are the question of debate.The presented case demonstrates the possibility of intracerebral hematoma formation as a result of the rupture of one of the multiple supratentorial CHs, which led to clinical deterioration and required urgent neurosurgical treatment. Although such clinical course is rare, it should be taken into account when planning treatment and informing patients with CH. A 62-year-old woman fell ill suddenly. The disease manifested with the onset of headache and left-sided hemiplegia At the local hospital, magnetic resonance imaging of the brain was performed and an intracranial hemorrhage in the right subcortical area due to rupture of the CH, and another asymptomatic CH in the triangle of the left lateral ventricle, ware founded. The patient initially received conservative therapy, but 48 hours after the onset of the disease, the patient's consciousness declined to 10 GCS points, and she was urgently transferred to the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», and an emergency operation was performed for removal of intracerebral hematoma and CH. Histological examination confirmed the diagnosis «cavernous hemangioma». The postoperative course was uneventful, and the neurological deficit regressed to mild left-sided hemiparesis. Indications and timing of surgical intervention in CH remain uncertain.