A case of cerebral venous angioma as an epileptogenic lesion detected by CT scan and surgically treated (author's transl)

Abstract

A case of cerebral venous angioma is presented. A 13-year-old boy suffering from uncontrollable adversive seizures to the left was admitted to the Kagoshima University Hospital. Neurologically slight hemiparesis on the left side was detected. In the electroencephalogram, spike-and-wave complexes were seen dominantly in the right frontal region. 99mTc-pertechnetate brain scan demonstrated no abnormal activities. Right common carotid angiography demonstrated no abnormalities in the arterial and capillary phases. However in the venous phase, a caput medusae-like or cone-shaped lesion was found in the white matter of the right frontal lobe and it consisted of numerous small veins. These veins drained centrally into a single large channel which coursed transcerebrally to reach the cortical surface and then drained into the vertex portion of the superior sagittal sinus. Computerized tomography (CT) before contrast enhancement demonstrated a slightly atrophic area localized in the right frontal lobe. After contrast enhancement, linear high density was seen in the subcortex of the right frontal lobe. Right frontal craniotomy was performed. The right frontal cortex was slightly atrophic and the angioma was extirpated surgically. Postoperatively, the patient was uneventful and discharged without any neurological defects. Adversive seizures disappeared. Histological examinations of the specimen revealed that these malformations consisted of numerous small veins separated by neural tissue and a cerebral venous angioma was diagnosed. Cerebral venous angioma is relatively common at autopsy, whereas clinically, it is the rarest type of cerebral vascular malformations. In the literature, only 18 cases of cerebral venous angiomas demonstrated by angiography were reported, and there has been only one report of CT findings in cerebral venous angioma.