Hyper-vascular giant cavernous malformation in a child: a case report and review.

INTRODUCTION: Giant cavernous malformation (GCM) in children is a rare vascular anomaly, and its natural history is unclear. Despite their giant size, intraparenchymal GCMs are low-flow vascular malformations. Herein, we report a case of hyper-vascular intraparenchymal GCM with an AV shunt in a child.

CASE: A 3-year-old boy had had an enlarged head since infancy. Magnetic resonance (MR) images on admission showed a strikingly enhanced mass lesion, 6 cm in size. A 4-vessel CAG demonstrated a hyper-vascular mass with an AV shunt. After transarterial embolization, the patient underwent total excision of the mass. The tumor bled easily, during surgery the patient lost 400 cm(3) in blood. Histopathological examination confirmed the diagnosis of cavernous hemangioma.

CONCLUSION: The differential diagnosis of intraparenchymal, strikingly-enhanced tumors with an AV shunt include hyper-vascular GCMs. Consideration of potential for bleeding during the operation is also important.