The surgical management of cerebral cavernous angiomas.

Cavernous angioma (CA) is a hamartomatous hemorrhagic lesion which has received a great deal of attention in recent years due to improvement of neuroimaging with magnetic resonance and heightened clinical awareness. Long considered to be rare, its actual prevalence is now recognized to be of 0.9%. Cavernous angiomas may be multiple, particularly in patients with familial form. It may be associated with a variety of clinical syndromes attributed to focal microhemorrhages or less frequently to gross bleeding. CA are usually diagnosed between the age of 20 and 50 with a highest clinical incidence in the fourth decade. A female predominance is observed in regard to bleeding. The male patients are more at risk for seizures. The recent series of MR imaging confirm that CA even when multiple can be asymptomatic in a significant number of cases. Surgery is the treatment of choice in order to eliminate the risk of hemorrhage and improve the control of seizures. Minimally invasive approaches are now adopted with reduced post-operative morbidity. We report our experience in surgical management of cerebral CA and suggest a classification of the lesions according to surgical accessibility and residual morbidity.