Angioma of the brain, skin, hemangioma, cavernoma: treatment, causes
Angioma is a vascular neoplasia, which is based on blood or lymphatic vessels. (Hemangioma — in fact, a synonym/subspecies, is angioma filled with blood). Most of these formations is found among children, including newborns as a congenital malformation. By the way, many authors give the angiom an intermediate position between a true tumor and malformation, but the ability to growth and recurrence do not allow to completely eliminate the angiom of the number of tumors.
The true prevalence of angioma is difficult to establish, because such tumors, obrazujas in the internal organs, can be asymptomatic. When the surface localization diagnostics is not working due to a cosmetic defect. Among patients children constitute up to 80%. The tumor is often located superficially in the skin, so it is usually diagnosed at birth. During the first years of life hemangiomas of the skin in children often regress, but there are cases and enhanced their growth.
Usually a vascular tumor located in the upper part of the body, and about 80% of cases occur in the head and neck. Such localization can be very dangerous, especially if the tumor formed in the brain, so without adequate surgical assistance is necessary. Leaking asymptomatic, angiomas of the internal organs and brain can for many years be not identified, and the diagnosis is established, usually after 30 years, when there be signs of dysfunction of the affected organ or the presence of intracranial education.
The types and causes of angioma
Causes of hemangioma consider:
- Congenital anomalies, when the vascular connection of the embryonic period continue to function after birth;
- Traumatic brain injury in the case of acquired angioma of the brain.
Angioma can be single or multiple (angiomatosis). In the latter case, a probable genetic predisposition to the formation of multiple vascular tumors.
Depending on the vessels that comprise the tumor, is isolated:
Separate species are lymphangioma, formed of lymphatic vessels. Often they are found in the tissues of the face, resulting in severe local edema and impaired lymphatic drainage. Large lymphangioma may form in the retroperitoneal space, mesentery of the intestine in the neck and limbs. Obstruction of lymph flow leads to swelling in the affected area of the body.
Arterial angioma built of blood vessels, the walls of which have a well-developed muscle layer. Capillary hemangiomas consist of small capillaries and often grow within the skin and mucous membranes.
The basis of venous angiomas leave the vessels, resembling veins – wide lumen and relatively thin wall. Externally, the neoplasia is similar to the node maroon or bluish color.
Cavernoma — cavernous angioma/hemangioma
Cavernous angioma is constructed of a wide variety of vascular cavities filled with blood. Usually this type of tumor is formed in the skin and looks like a soft bluish lumpy node, turning pale when pressed. Due to the accumulation in the tumor of blood, to the touch it will be warmer than the surrounding tissue. In the Lumina of the vascular cavities (caverns) can be detected by blood clots, sometimes dense, obyzvestvleniya, giving the tumor an uneven consistency.
Cavernous hemangioma may be incidentally discovered in the internal organs, for example, in the liver. Such a tumor usually does not cause anxiety and is detected incidentally during examination for other diseases. At the risk of rupture of vascular cavities raises the question of the removal or sclerotherapy of education, while in stable for angiomas of small dimensions can be limited to observation.
Symptoms of angioma of different localization
Angioma located in the skin, usually do not cause any inconvenience except for the external defect. It is the change in appearance, especially when the tumor located on the face, neck, hands, often becomes a reason for visiting the doctor.
Superficial angioma of the skin is able over time to ulcerate, to bleed, and the blood vessels it can trombirovania, then the patient will experience pain. Inflammation in the tumor may be accompanied by the accession of infection.
Angioma of the internal organs does not manifest itself or causes the violation of their functions. When the tumor in the bones or muscles can be a pain, tendency to pathological fractures. Angioma of the mucous membranes can bleed, leading to the nasal, gastrointestinal bleeding, etc.
Angiomas of the spinal cord occur with a radicular syndrome and pain due to compression of spinal nerve fibers. The pain reminds in the pathology of intervertebral discs and quite intense. If the tumor compresses the spinal cord itself, it is possible paresis and paralysis.
Signs of angioma of the brain
Particularly noteworthy hemangioma of the cerebral hemispheres and the cerebellum, which for a long time may be asymptomatic and are discovered either accidentally, or by the occurrence of hemorrhage. Of deep seated angiomas can lead to serious disorders of the brain, to call «robbing» of the nervous tissue due to impaired blood flow and increased intracranial pressure, seizures.
Vascular tumors of the frontal lobe may cause changes of mentality and behavior, seizures, impaired vision, when compression of the optic nerves. Patients formed the characteristic «frontal mentality» when a person loses control over actions, decreased criticism, disturbed speech.
The defeat of the cerebellum is accompanied by impaired coordination of movements, balance, gait, fine motor skills. Patients concerned about dizziness, nausea, inability to make purposeful movements. Pathology of the right lobe of the cerebellum can cause speech disorders. Located near the brain stem is one of the most dangerous and inaccessible locations of the tumor. Damage to vital nerve centers of this region (blood vessels, musculoskeletal, respiratory) may cause cardiac and respiratory arrest.
Vascular tumors of the parietal lobe provoke seizures, impaired hearing, thinking, loss of the ability to understand and reproduce it. Suffering sensitive area, the patient does not feel pain, temperature of objects, touching, etc.
Regardless of, affected the right or left hemisphere brain tumor leads to increased intracranial pressure, accompanied by intense headache, nausea, vomiting, sometimes convulsions syndrome. Often prolonged intermittent headache is the only symptom of vascular malformations of the brain.
Diagnosis and treatment
Diagnosis of superficial angiomas is not too difficult, and the physician during the examination will suggest the correct diagnosis.
At angioma of the internal organs may require ultrasound with Doppler, CT, MRI, or contrast-enhanced magnetic resonance angiography.
The choice of treatment angiomas depends on its size, location and risk of rupture of the vessels. The main methods used currently are:
- Surgical removal of tumors;
- Embolization of tumor vessels.
In cases where the tumor is small, does not increase in size and does not bother the patient, and the risk of rupture with hemorrhage is minimal, your doctor may suggest monitoring. Usually take wait-and-see tactic with superficial angioma of the skin. In children these tumors may regress by themselves within 3-4 years of life, so it makes sense to wait for its disappearance, because the removal can be traumatic and lead to scar formation.
Indications for removal of the angioma consider:
For superficial hemangiomas may use gentle techniques, such as electrocoagulation, laser destruction, cryotherapy. Removal of the tumor with electrical current, liquid nitrogen or laser has a good cosmetic effect, so it can be applied for tumors of the skin. However, when a large area of the angioma, it is better to use irradiation because of the risk of scarring, and sometimes positive effect of the appointment of prednisolone.
With deeply located tumors use sclerosing therapy. The method is based on the introduction of a substance that causes sclerosis and obliteration of the vessels of the gaps that make up the tumor. Usually used for this purpose is 70% ethyl alcohol, which hit in the vessels cause the development of local inflammation and scarring. Vessels cease to function, and angioma disappears.
Local methods of tumor removal can be painful and require a certain amount of time to heal from the impact zone, therefore during the procedure should be pain relief. It is especially important to consider this fact when treating small children.
Surgical treatment involves complete excision of the tumor, the sewing of the vessels, forming a tumor the ball, the ligation of the vessel carrying blood to the tumor. Surgical removal leads to complete cure, but not all of angiomas can be accessible to the scalpel of the surgeon because of the location in the internal organs or the brain.
Endovascular embolization is performed using a catheter which enters into the tumor substance that causes blockage of blood vessels. Method is not always radical, so it is combined with surgery or radiation.
There is information about the possibility of conservative treatment of hemangiomas of drugs from the group of beta-blockers. These drugs usually assigned for arrhythmias and heart failure, but their low doses can lead to the regression of hemangioma. Unfortunately, the scheme of conservative treatment of hemangiomas has not been developed in most countries of the former Soviet Union, therefore, undertake not carry out all the experts, and choosing the drug and its dosage, the doctor is based on personal experience and intuition. Described cases a great effect in medical treatment of hemangiomas in children, especially, are located in open areas of the body, when tumor removal can lead to scarring.
Treatment of angiomas of the brain
Special attention deserves the treatment of angiomas of the brain, as the risk from open surgery is quite high. In addition to rupture of tumor vessels and hemorrhage, there is a possibility of nerve damage during the surgery. Often the tumor is so deep that the operation is impossible due to its inaccessibility.
If angiomas can be removed surgically without the risk of dangerous complications, such surgery is the neurosurgeon. In other instances, the minimally invasive techniques and radiation.
Embolization of tumor vessels can be carried out in deeply located small angioma of the brain. Sclerosing substance is injected in the catheter and causing the obliteration (obliteration) of tumor vessels. In such operations it is likely that not all vessels will be closed, so the tumor will not disappear completely. To avoid re-growth of tumors method is supplemented by surgery or radiotherapy.
Radiosurgery of angiomas of the brain
A very promising method that is increasingly used for the treatment of tumors of the Central system is considered radiosurgery (gamma-knife or cyber-knife). Irradiation of the tumor with a beam of radiation causes sclerosis of the vessels that make up the angiom. The surrounding tissue is not affected, which is especially important when intracranial location of the tumor.
The disadvantage of radiosurgery is considered to be the gradual disappearance of the tumors, which can take from several months to a year. Unlike other tumors, is gradually regressing, and not delivering when it concerns the patient, the angioma to full recovery retains the ability to rupture of vessels and hemorrhage. In this regard, radiosurgical treatment is indicated for small dimensions of the tumor or in the case of the depth of her location when radiation becomes the only method of treatment.
Some patients with incomplete closure of tumor blood vessels, is assigned the procedure of irradiation, and then the efficiency reaches 95% or more.
Cyber-knife and gamma knife are some of the differences that the patient found helpful. So, CyberKnife assumes absolute non-invasiveness, when the beam of radiation aimed at the tumor, and the device itself adapts to the body position of the patient, there is no need to lie still. The impact of gamma knife does not involve movement of the radiation source, therefore, the irradiated region is fixed in space while the head is attached with needles stereotactic frame. The procedure can be painful, so the patient is local anesthesia of the scalp.
When accomplished bleeding from angiomas shows the evacuation of blood clots from the brain, if it is technically possible, and further therapy is aimed at elimination of neurological disorders.
Timely treatment of angiomas avoids rupture and dangerous complications. Many patients, having heard or having read online horror stories about the surgical treatment of angiomas of the brain, afraid to remain forever disabled after the surgery, therefore, delay the treatment or even refuse it. This should not be done, as rupture and hemorrhage can occur at any moment, and the emotions and stress in connection with the presence of tumors provoked excessive emotions, rises in blood pressure that this moment can only bring. In the presence of a diagnosis of angioma of the brain need to rely on experienced technician and undergo a recommended treatment, then the illness and would not pose a threat to health and life.