Affiliations: Department of Clinical Neurological Sciences, Division
of Neurosurgery, London Health Sciences Center, University of Western Ontario,
London, ON, Canada | Schulich School of Medicine and Dentistry, London
Health Sciences Center, University of Western Ontario, London, ON, Canada
Note: [] Correspondence: Dr. Adrianna Ranger, Children's Hospital London
Health Sciences Center, 800 Commissioners Road East, Room E6-315, N6C 6B5,
London, ON, Canada. Tel.: +1 519 685 8107; Fax: +1 519 685 8171; E-mail: aranger@uwo.ca
Abstract: Cavernous hemangiomas (CH) are occult vascular malformations,
typically presenting as hemorrhage within a cerebral hemisphere, or as
seizures. Brainstem and cerebellar locations of these lesions are less commonly
described. Potentially very serious, they tend to result in severe deficits or
death. We review the existing scientific literature on their presentation and
course during pregnancy. Relevant cases were identified through electronic
searches of multiple internet search databases, including PubMed, SciSearch,
Scientific Commons, Springer Link, and Google, using advanced search functions
and multiple search terms, using both American and British spellings. Detailed
literature review revealed, including our own single case, 26 patients, ranging
from 15 to 37 years, with 28 episodes of CH presenting during pregnancy. Two
thirds occurred in the third trimester. Supratentorial lesions all presented
with seizures, but without neurological deficits or documented hemorrhage, and
all patients did well. Conversely, infratentorial lesions always presented with
neurological deficits, usually with hemorrhage and never with seizures, and
outcomes were quite variable, including maternal and fetal deaths. CHs are rare
in pregnancy, but can affect pregnant women of any age, tending to occur in the
3rd trimester. Supratentorial CH present with seizures and patients generally
do well. CH within the brainstem present with hemorrhage, and such patients
have a guarded prognosis. If far enough into gestation, immediate delivery of
the fetus and resection of the lesion are recommended.
