Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Nat Rev Neurol. 2009 Dec;5(12):659-70. doi: 10.1038/nrneurol.2009.177.
Cavernous malformations (CMs) consist of dilated vascular channels that have a characteristic appearance on MRI. CMs are usually found intracranially, although such lesions can also affect the spinal cord. Individuals with CMs can present with epilepsy and focal neurological deficits or acute intracranial hemorrhage. In many cases, however, patients with such lesions are asymptomatic at diagnosis. Furthermore, several natural history studies have documented that a substantial proportion of asymptomatic CMs follow a benign course. Surgical resection is recommended for CMs that require intervention. Radiosurgery has been advocated for many lesions that have not been easily accessible by conventional surgery. The outcomes of radiosurgery and surgery for deep lesions, however, vary widely between studies, rendering treatment recommendations for such CMs difficult to make. In addition to reviewing the literature, this article will discuss the current understanding of lesion pathophysiology and explore the controversial issues in the management of CMs, such as when to use radiosurgery or surgery in deep-seated lesions, the treatment of epilepsy, and the safety of anticoagulation.
海绵状血管畸形（CM）由扩张的血管通道组成，在 MRI 上具有特征性表现。CM 通常在颅内发现，尽管此类病变也可能影响脊髓。CM 患者可出现癫痫和局灶性神经功能缺损或急性颅内出血。然而，在许多情况下，此类病变患者在诊断时无症状。此外，几项自然病史研究表明，相当一部分无症状的 CM 呈良性病程。需要干预的 CM 推荐手术切除。放射外科已被用于许多传统手术难以触及的病变。然而，放射外科和手术治疗深部病变的结果在不同的研究中差异很大，使得难以对这些 CM 做出治疗建议。除了回顾文献外，本文还将讨论目前对病变病理生理学的理解，并探讨 CM 管理中的争议问题，例如何时在深部病变中使用放射外科或手术、癫痫的治疗以及抗凝的安全性。
