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Three-dimensional time-of-flight MR-angiography and the surgical indication of brainstem cavernomas.

B. Wowra, G. Layer, L. Schad, B. Ullrich, W. Semmler, A. Aschoff, M. Kiessling and S. Kunze

Acta Neurochir (Wien), 112 (3-4), pp.77-82

This study was designed to assess the diagnostic value of 3D time-of-flight MR-angiography in cerebral cavernomas. In seven patients, nine out of ten cavernomas were removed by microsurgery. While MR-angiography demonstrated well branches of brain arteries adjacent to the lesions, no flow signal in the vascular malformations was observed. On the other hand, there was a high intensity signal induced by methaemoglobin in those three patients with brainstem cavernomas who had experienced a significant bleeding attack seven months prior to admission. It had a spotted appearance in MR-angiography with volumes of the largest spots around 1.8 cm3. It is suggested that this spot signal could be used as a path marker for the surgical approach in brainstem cavernomas.