Case series of giant Cavernomas: Clinical presentation and management recommendations

Background: Cavernous malformations are vascular anomalies filled with blood at different stages, nonetheles, there is no precise definition for giant cavernomas. Literature suggests a cut-off at 6 cm to classify them as giant. This is a rare pathology with few case reports, and there are no specific recommendations for giant cavernomas. We made a review of information previously published and based on our experience we propose a series of recommendations for surgical treatment of giant cavernous malformations. Methods: A retrospective review of the patients treated at the Neurosurgery Department in Centro Me ' dico Nacional Siglo XXI was made. Only those with a final histopathological result of cavernoma and a MRI with a maximum diameter equal to, or greater than 6 cm were selected. Results: The cases of five patients (3 females and 2 males), who had a surgical resection are presented. They all have heterogeneous clinical manifestations and presumptive diagnosis upon admission. The diagnosis of giant cavernoma was confirmed through histopathology. Conclusion: Even though a diagnosis of cavernoma is not uncommon, giant cavernomas are rare. They should be considered in the differential diagnosis of medically refractory epilepsy, neurological focalization, and cerebral hemorrhages that increase or do not decrease its volume during follow-up. When achievable, surgical total resection is the treatment of choice for these lesions.