Recurrence of an excised cavernous hemangioma in the opposite cerebral hemisphere. Case report.

Abstract

This Italian boy was first seen in 1965 at age 15 when an intraventricular cavernous hemangioma of the right lateral ventricle was demonstrated angiographically (Fig. 1) and removed? He was followed periodically by the author. The only postoperative problem was infrequent grand mal seizures for which he was placed on Dilantin and phenobarbital therapy. His mental and physical development proceeded normally, and he graduated from high school at age 18 with average marks. In March 1968 he complained of a few headaches which were not very severe. Neurological examination did not reveal any abnormality; there was no papilledema. An electroencephalogram (EEG) done at that time showed there was slow wave focus in the right frontal region, which was considered compatible with the surgical interference in that area. A new finding was some abortive paroxysmal activity in the left frontal region. A brain scan performed in September 1969 showed an area of slightly increased uptake in the left frontal region. There was no evidence of any increased uptake in the region of the previous lesion. Examination. In January, 1969, the patient again complained of headaches and dizziness, and was hospitalized. Neurological examination revealed that he had bilateral papilledema. Bilateral carotid angiography (Fig. 2) demonstrated an avascular mass in the left frontal region. There was no evidence of recurrence of the previous lesion. Operation. On January 15, 1969, a left frontal craniotomy was performed, and a very large lesion was encountered in the left frontal lobe. The gross appearance was that of an encapsulated mass with dark brown solid tissue inside it. There were numerous areas of hemorrhages both recent and old. The total size of the tumor was approximately that of a tennis ball. The lesion was removed almost completely. Postoperative Course. Recovery was smooth. The patient was discharged home in good condition and had had no grand real seizures up to the time of the last check-up in December, 1969. The papilledema had resolved completely. Pathological Report. The specimen consisted of three portions. Two of these were