Combination of multiple cerebral cavernous malformations with a falx meningioma: A clinical case

Introduction. Cerebral cavernous malformations may coexist with various disorders of the central nervous system, including brain tumors. There are few descriptions of combined cavernous malformations and meningiomas in the literature. When a cavernous malformation co-occurs with a tumor, the diseases may have various progression trajectories, and symptoms may appear in different sequences over many years. The present case describes the detection of multiple de novo cavernous malformations of the brainstem and the right subcortical region 14 years after the total resection of a meningioma arising from the posterior third of the falx cerebri.

Case description. A 55-year-old woman was transferred from the Abinsk Central District Hospital to the Research Institute — Prof. S.V. Ochapovsky Regional Hospital No. 1 with complaints of dizziness, gait instability, dysarthria, dysphagia, and nausea. According to her history, on 14 February 2008 she had undergone successful resection of a meningioma of the posterior third of the falx cerebri. For five years she was regularly followed by a neurosurgeon at the consultative and diagnostic center of Prof. S.V. Ochapovsky Regional Hospital No. 1; no evidence of tumor re-growth or other intracranial pathology was found, after which she discontinued follow-up. Fourteen years later she developed sudden-onset dizziness, gait instability, speech and swallowing disturbances, and nausea. Examination revealed cavernous malformations of the brainstem and right subcortical region. The brainstem cavernous malformation had presented with intracerebral hemorrhage. The pronounced neurological deficits were an indication for surgical intervention. A midline suboccipital craniotomy with resection of the brainstem cavernous malformation was performed. Neurological deficits regressed during postoperative management.

Conclusion. The combination of multiple cavernous malformations and meningiomas is rare. Surgical treatment should be guided by the pathology that is clinically dominant at the time. Resection of a brainstem cavernous malformation can improve functional outcomes.

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