Intraparenchymatous Hemorrhage caused by Angiographically Occult Cerebral Vascular Malformation and Hemangioblastoma

Abstract

Cerebral vascular malformation (CVM) and hemangioblastoma were verified pathologically in 14 of the 17 operated cases with lobar (15 cases) or cerebellar (2 cases) hematoma with no abnormal vessels or tumor blush on angiograms during the past eight years. Six of the 9 CVM cases and 2 of the 5 hemangioblastoma cases were over 60 years in age. Eight of the 14 cases had definite hypertension before and after surgery. The symptoms developed suddenly without preceding apoplectic histories in all cases. Computerized tomography scan disclosed oval shaped hematoma in 11 cases, but no definite enhanced mass within or around the hematoma in any case. The operation was undertaken under a surgical microscope for searching abnormal vessels or tumor mass around the hematoma. Histologically, eight were small arteriovenous malformations and one was a large cavernous angioma. Five hemangioblastomas were diagnosed as transitional type according to Silver and Hennigar's classification. The authors' operative technique is described herein and the significance of the hemorrhage from the angiographically occult CVM and hemangioblastoma is discussed. © 1985, The Japan Neurosurgical Society. All rights reserved.