Cavernous Malformations of the Brain and Spinal Cord

Cavernous malformations are discrete vascular abnormalities affecting the brain and spinal cord. They have very sluggish blood flow through them, with no arterio-venous shunting. The very slow blood flow makes them typically not visible on angiography (often referred to as ‘angiographically occult’). These lesions were previously considered to be rare. However, with the widespread availability of high definition CT and MRI scans, they have been identified much more commonly and are now thought to be present in approximately 0.5% of the population. Although it is unusual for cavernous malformations to be responsible for a large intracerebral bleed, they commonly show haemosiderin staining around them. It is considered that in the brainstem they have a significantly higher incidence of symptomatic bleeding than elsewhere in the brain. The haemosiderin staining and cerebral reaction to subcortical hemispheric lesions also result in these being the not infrequent cause of seizures. The publication of this book is timely in that there has been a significant amount of controversy regarding these lesions, and questions regarding the most appropriate management are complex and perplexing. Although this multi-authored publication is a relatively small book (130 pages in 17 chapters), it provides a concise, wellresearched text which is both academic and clearly addresses practical issues facing treating clinicians. Although the primary audience would be neurosurgeons and neurologists, it would also be useful for neuroradiologists and pathologists. This book addresses the major changes in our knowledge regarding these lesions (such as the apparent increase in incidence/ diagnosis, the differentiation of both familial and sporadic forms, and the genetic basis). It also addresses in a balanced way continuing controversies such as apparent increase risk of symptomatic bleeding in eloquent areas, and whether surgical resection should be recommended in such areas, particularly the brainstem. Also, the ongoing controversy regarding whether there is any role for radiosurgery in the management of these lesions is appropriately discussed. Dr Spetzler and Lanzino, the editors of this publication, are very well respected in the neurosurgical community and have acknowledged expertise in this area. They have invited a wide range of experienced contributors for individual chapters. The result is a well laid out and logically arranged text, and it is presented in a readable style which is well indexed. The binding, quality of paper, and general presentation of the book are excellent. This is certainly a book I would wish to own. I believe it is not only of interest to cerebrovascular neurosurgeons, but would be of particular interest to all practicing neurologists and neurosurgeons, and warrants inclusion in any neuroscience library.