Introduction: Brain capillary telangiectasias (BCT) are usually small and benign with a predilection in pons and basal ganglion25. Large and symptomatic BCTs are rare and have a higher risk of causing hemorrhage, neurological defects, and even death. Due to the lack of report, diagnosis of large BCTs has been difficult30-31 and strategies of management are undefined.

Methods: We retrospectively reviewed all cases of BCTs treated in a single institution between 2006 to 2011. Clinical presentations, radiological findings, surgical managements, histopathological characteristics and peri-operative complications were analyzed.

Results: Five symptomatic, large or giant BCTs were treated in a single institution between 2006 and 2011. The mean size of the BCTs was 5.06cm (range 1.8cm to 8cm). Four patients presented with focal or generalized seizures and one patient with transient vision loss. The locations of the lesion were frontal, temporal lobe, hippocampus, and temporal occipital lobe. Gross total resections of the lesions were achieved in all patients. After the surgery, the four patients with seizures were symptom free for follow-up periods varying from over 1 to 5 years with no additional neurological deficits

Conclusions: The unique location, radiological characteristics, and clinical course suggest giant BCT could be a different entity with small BCT. Surgical resection is safe and effective for patients with poorly-controlled neurologic symptoms, especially those with surgically accessible locations. Complete removal would anticipate relief of the symptoms without causing new neurologic deficits.

Patient Care: Surgical resection is safe and effective for patients with poorly-controlled neurologic symptoms, especially those with surgically accessible locations. Complete removal would anticipate relief of the symptoms without causing new neurologic deficits.

Learning Objectives: Radiological features of giant brain capillary telangiectasias. Outcome of surgical resection of giant brain capillary telangiectasias. Histopathological characteristics of giant brain capillary telangiectasias.

References: 1. Pozzati, E., et al., The neurovascular triad: mixed cavernous, capillary, and venous malformations of the brainstem. J Neurosurg, 2007. 107(6): p. 1113-9. 2. Tang, S.C., et al., Diffuse capillary telangiectasia of the brain manifested as a slowly progressive course. Cerebrovasc Dis, 2003. 15(1-2): p. 140-2. 3. Tomlinson, F.H., et al., Angiographically occult vascular malformations: a correlative study of features on magnetic resonance imaging and histological examination. Neurosurgery, 1994. 34(5): p. 792-9; discussion 799-800.