Temporal cavernoma with post-op SDH

Case contributed by Assoc Prof Frank Gaillard


Temporal lobe epilepsy.

Patient Data

Age: 55
Gender: Male

In the left parahippocampal gyrus is a peripherally hemosidering lined lesion consistent with a cavernous malformation. 

They went on to have a resection. 


MICROSCOPIC DESCRIPTION: Sections show a nidus of thin walled vessels with a back-to-back arrangement and containing blood clot. Vessel walls are composed of homogenous hyalinised collagen. The adjacent brain parenchyma contains abundant haemosiderin laden macrophages, consistent with previous haemorrhage. There is associated mild gliosis. There is no evidence of malignancy. The features are of cavernous haemangioma.

DIAGNOSIS: Cavernous haemangioma.


Post op MRI 3 months later

A left-sided craniotomy is noted, with post surgical change extending through the temporal lobe to the site of previous cavernous malformation, which now appears resected with no convincing residual cavernoma evident, and only a small amount of residual hemosiderin staining. A 17mm deep subdural collection extends over the left cerebral convexity exerting significant local mass effect and 5 mm midline shift. The remainder of the brain is unremarkable.

Left temporoparietal craniotomy noted. Left cerebral convexity subdural hematoma is mostly isodense to brain parenchyma and measuring up to 20 mm in depth. Mass-effect with effacement of the left cerebral sulci, effacement of the body and trigone of the left lateral ventricle and midline shift towards the right up to 5 mm at the septum pellucidum.

No CT evidence of acute cortical ischemia. No hydrocephalus.

Case Discussion

Cavernomas are quite epileptogenic and thus a lesions worth carefully seeking when evaluating a patient with epilepsy. In this case not only is the cavernous malformation large but also closely related to the hippocampus. 

Post operative subdural hematoma with a good example of isodense collection on CT. 

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Case information

rID: 28910
Published: 5th May 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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