History of Management of Cavernous Malformations in Children

Understanding of Disease

• 1951 – autopsy description of cavernous malformation: Attention was called in 1951 to the unknown cause of cerebral hemorrhage in healthy young patients, including children. In some, underlying cavernous malformations were found at autopsy (38). Historically, cavernous malformations were designated as cryptic lesions (57). They are not visualized on conventional arterial angiography (64).
• 1980s – establishment of incidence: The incidence rate in the population was established through large series of postmortem studies in the 1980s (40, 44).
• 1990s – description of heritable form: Analysis of familial lesions (predominantly noted in Hispanic kindreds) led to the discovery of the autosomal dominant inherited form of the disease (70).

Technological Development

• 1970s–1980s – improved imaging leads to treatment: Cavernous malformations had once been thought not to be surgically treatable. However, the advancement of neuroradioimaging techniques such as CT and MRI and the improvement of surgical instruments including the microscope and/or fine surgical tools have led to a new concept for managing these lesions (24, 30, 50, 53).
• 1990s – stereotactic guidance and IOM: Is is no longer impossible to resect cavernous malformations from the brainstem (22). Stereotactic guidance and electrophysiological monitoring have become the standard supplementary tools to maximize the outcome for resection of these lesions in the brainstem (29).