Intraventricular Cavernomas of the Third Ventricle: Report of 2 Cases and a Systematic Review of the Literature

Abstract

Background: Intraventricular cavernous malformations are relatively rare benign vascular malformations. Patients may be asymptomatic or present with headache, seizure, hemorrhage, or neurologic deficits. We report 2 cases of patients with cavernomas in the third ventricle and at the foramen of Monro. We also performed a systematic review of the literature to examine the clinical features and efficacy of the current standard of care for these lesions.

Methods: We performed the systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were queried; the title/abstract and MeSH keywords used included "cavernous malformation," "cavernoma," "cavernous hemangioma," "cavernous angioma," "foramen of Monro," "third ventricle," and "intraventricular," along with "AND" and "OR" operators. Patient demographic and clinical data were collected for qualitative synthesis.

Results: Patients presented at a median age of 38 years; the most common symptom was headaches. Gross total resection was performed in 84.6% of patients, and 81.8% had clinical improvement with intervention. The incidence of intraventricular hemorrhage and hydrocephalus was 15.4% and 59%, respectively.

Conclusions: The specific location of the cavernoma determines clinical features seen and approach used in surgical resection. Ventriculoperitoneal shunting was not required in most cases, as hydrocephalus improved with removal of the obstruction at the foramen of Monro. Gross total resection appears to be the optimal management strategy in symptomatic patients and leads to a good outcome in most cases.

Keywords: Cavernoma; Cavernous malformation; Endoscopic; Intraventricular.