Clinical Features and Treatment of Cavernous Angiomas in The Fourth Ventricle: A Series of Six Patients and Review of The Literature

摘要

Background: Cavernous angiomas are vascular malformations rarely found in the ventricular system. Fourth ventricular cavernous angiomas (FVCAs) are even rarer and have only been sporadically reported.Methods: We present a series of six patients with FVCA who were treated in our institute. The clinical data were analyzed retrospectively. Follow-up was obtained based on clinical observation. In addition, we also analyzed the clinical, neuroradiological, and surgical characteristics of fourteen cases of FVCAs that have been reported in the literature.Results: The series includes four males and two females (range: 25 to 58 years; mean 41.6 years). The initial clinical presentation consisted of increased intracranial pressure/ hydrocephalus in five cases, absence of symptom in one patient. All patients underwent direct surgical excision of the FVCAs and all achieved total removal. Postoperatively, one patient had intracranial infection and recovered after appropriate anti-inflammatory therapy, one patient had respiratory depression, hydrocephalus, and recovered after symptomatic treatment, and four patients had cranial nerve deficits. Follow-up was achieved in all patients with a mean follow-up time of 90.5 months. One case had hydrocephalus post-operative 6 months and had another ventriculoperitoneal shunt. No patients had recurrence. Three patients had regained their normal neurological baseline; the other three patients had persistent mild to medium cranial nerve deficits.Conclusions: FVCAs are benign lesions; hydrocephalus and cranial nerve deficits might be the initial presentation of this rare ailment. Microsurgical total removal of FVCAs is the treatment of choice; however, the surgery of FVCAs increases the risk of postoperative cranial nerve deficits.