Introduction: Mixed vascular malformations are now being described with increasing frequency. The most commonly reported pathological patterns are cavernous malformations associated with other vascular malformaitons, such as venous anomalies, arteriovenous malformations and capillary telangiectasias. Their identification and de novo growth illuminate the hypotheses about common pathogenesis among different types of lesions, which in turn lead to controversy on the management strategies.The clinical profiles of mixed CM with venous anomalies were reviewed to better understand their features, and to evaluate the feasibility of our imaging and surgical protocols.

Methods: The magnetic resonance images, histological sections, and clinical information were reviewed in 28 patients with mixed CM and VM undergoing surgical excision at a single institution.

Results: The most frequent site was in the temporal lobe (12/28, 43%), followed by frontal lobe, and brainstem (6/28 and 4/28). Half the patients (13/26) presented with seizures. Most lesions exhibited a “mulberry” core and hypointense ring with linear signal loss or enhancing “caput medusa” on MR imaging studies. Enlarged converging veins or multiple feeding arteries were generally present in surgery in 13 of 26 patients. Most of the CMs were total resected with concomitant VMs and dilated arterioles coagulated. Although radical resection was not achieved in one patients with multiple cavernoma, no rebleeding or de novo recurrence occurred in our series. Also importantly, the postoperative MR images and pathologic examination of surgical specimens confirmed the excision of associated vessels at the length of CM lesions.

Conclusions: The hemodynamic and architectural status of mixed CM -VM lesions appears to be more aggressive than that of pure CMs. MR image of mixed lesions was efficient in the evaluation of vascular relationship in the context of surgical planning. Proximal excision and coagulation of VMs and dilated arterioles, even with residual CM lesions, were safe and effective surgical management for mixed CM-VM following good outcomes and short-term prognosis.

Patient Care: Our research would provide experience and evidences to formulate a more safety and effective management consensus on the cavernous malformation associated with venous anomalies, which means early diagnosis, better pre-operative surgical planning, aim-oriented surgical treatment, optimal outcomes evaluation system rooted in molecular pathogenesis findings.

Learning Objectives: By the conclusion of this session, participants should be able to:1)Desicribe the importance of conventional MRI(T2WI and contrast image) in pre-operative recognization and surgical planning of CM associated with VM. 2)Discuss, in small groups, an optimal surgical management protocols of CM-VM with good outcomes and mild complications. 3)Identify an effective treatment evaluation system guided by pathological findings which would be supplemented by advances in molecular pathology.

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