Original Article   

Journal of Neurosurgical Sciences 2022 Apr 13

DOI: 10.23736/S0390-5616.22.05574-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Surgical management of pediatric intracranial CCM: a 10-year single center experience

Tommaso CALLONI ^{1, 2}, Andrea CARAI ² ✉, Francesco LIOI ³, Marilou CAVALIERE ^{1, 2}, Alessandro DE BENEDICTIS ², Sabrina ROSSI ⁴, Franco RANDI ², Maria C. ROSSI ESPAGNET ⁵, Marina TRIVISANO ⁶, Claudia CESARIO ⁷, Elisa PISANESCHI ⁷, Alessandra MARASI ², Alessandra SAVIOLI ⁸, Carlo G. GIUSSANI ^{1, 9}, Carlo E. MARRAS ²

¹ Department of Medicine and Surgery, University of Milano-Bicocca, School of Medicine, Milano, Italy; ² Neurosurgery Unit, Department of Neurosciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; ³ Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; ⁴ Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; ⁵ Neuroradiology Unit, Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; ⁶ Neurology Unit, Department of Neurosciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; ⁷ Translational Cytogenomics Research Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; ⁸ Department of Anesthesia and Critical Care (ARCO), IRCCS Bambino Gesù Children's Hospital, Rome, Italy; ⁹ Neurosurgery Unit, Department of Neurosciences, Ospedale San Gerardo, Monza, Italy

BACKGROUND: Cerebral cavernous malformations (CCMs) are low-flow vascular malformations made up of dilated vascular spaces without intervening parenchyma that can occur throughout the central nervous system. CCMs can occur sporadically or in familial forms. Presentation is diverse, ranging from asymptomatic discoveries to drug-resistant epilepsy and hemorrhages.
METHODS: We describe the surgical management of CCMs in pediatric patients at Bambino Gesù Children’s Hospital in Rome over the last 10 years. The cases have been stratified based on the clinical presentation and the relevant literature is discussed accordingly.
RESULTS: We discuss the rationale and technique used in these cases based on their presentation, as well as the generally positive outcomes we achieved with early surgical management, use of intra-operative ultrasound (ioUS) and intraoperative neuromonitoring.
CONCLUSIONS: Surgical management of pediatric CCMs is a safe and effective strategy, low rates of postoperative morbidity and partial resection were observed.

KEY WORDS: Pediatric cavernoma; CCM; Intracranial vascular malformation; Intraoperative ultrasound cavernoma; Cavernous angioma