Cavernous Angioma

Diagnosis

Multiple cavernous angiomas of the cerebral hemispheres and the pons.

Response from neurosurgeon Professor Martin Scholz

The MRI scans show multiple cavernous malformations, including a left pontine cavernous angioma measuring 20×13×17 mm, and a cavernoma in the right basal ganglia region measuring approximately 5 mm. There are also three very small cavernous angiomas in the right frontal lobe. The patient's symptoms include numbness of the right side of the face and the right forearm, without dermatological correlation. She also reports mild headaches.

Imaging demonstrates edema surrounding the pontine cavernous angioma. Such a lesion is difficult to remove, but surgical resection is possible in the sitting position, through the fourth ventricle and under neuronavigation guidance.

Patient Question

• If surgery is unavoidable, how soon does it need to be performed?

Physician’s Answer

When neurological symptoms are progressing, surgery becomes necessary. The main concern is the risk of hemorrhage. If a pontine cavernoma begins to bleed, nothing will remain as it was before — this may result in severe neurological deficits, complete paralysis, or even death. Surgery also carries risks, but postoperative symptoms usually improve over time.

If no intervention is performed, the risk of hemorrhage must be taken into account. The statistics for this condition are as follows: a 0.5% risk of hemorrhage for each remaining year of life. If the patient is expected to live another 50 years, the cumulative hemorrhage risk is approximately 25%. This is considerably higher than the postoperative risk, which is around 6–7%.

Estimated cost of treatment: €29,800

Treatment Provided

Prior to surgery, the following diagnostic assessments were performed:

• TEE (transesophageal echocardiography) to rule out PFO (patent foramen ovale), ASD (atrial septal defect), or atrial septal aneurysm.
• Preoperative CT navigation planning due to the location of the pontine cavernoma.
• MRI of the spine to rule out spinal cavernoma.

A microsurgical resection of the pontine cavernous angioma was performed using neuronavigation. The surgery proceeded without complications. Postoperatively, the patient experienced diplopia, which resolved by day 7. The remainder of the postoperative period was uneventful. The patient was discharged on postoperative day 10 in good condition.

Final cost of treatment: €24,870

Patient review

I would like to share my experience with the medical support center represented by Konstantin. I have known Konstantin for many years, and when I suddenly found myself alone with a diagnosis of a brain cavernoma, in Tashkent with MRI images in my hands, it was clear to me that I needed to contact leading European specialists — something that Konstantin could arrange.

I immediately sent my scans and diagnosis, and the very next day I received an expert opinion from a specialist I trust — Professor Martin Scholz, neurosurgeon at Sana Klinikum Duisburg. He provided a detailed answer despite it being a Sunday. Konstantin translated the opinion promptly and sent it to me right away.

I understood the risks of leaving the condition untreated, as well as the risks of surgery, which Professor Scholz agreed to perform. I decided to proceed and asked to schedule the operation in two weeks. Konstantin arranged everything: my appointment at the clinic, accommodation, airport pick-up. He personally met me, brought me to the clinic, assisted with everything, and provided interpretation from German. Although we could communicate in English, the medical terminology required precise translation, which Konstantin handled flawlessly.

His presence was invaluable. Two days later I underwent surgery. As expected, there were some temporary postoperative symptoms. Professor Scholz was satisfied with the outcome — the surgery was successful. I began gradually recovering my vision and coordination. I started walking, and two weeks later I returned to Tashkent and resumed work.

Four months later, follow-up imaging showed excellent results. Professor Scholz was pleased. I hope none of you ever need this information, but if you face a similar situation — know that help is available.

Anna

Early diagnosis and treatment significantly improves outcomes.
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