Cerebral capillary telangiectasias: a meta-analysis and review of the literature

As a result of their presumed benign natural history, cerebral capillary telangiectasias (CCTs) are infrequently addressed in the neurosurgical literature. We performed a comprehensive review of CCTs via the PubMed database to synthesize overall epidemiological, radiographic, natural history, and treatment results. Across ten series with 203 patients, mean age was 47, and 45 % were male [95 % confidence interval (CI), 0.30–0.65]. Notably, 78 % of CCTs were in the pons (95 % CI, 0.58–1.0). Six percent of CCTs were symptomatic. Across five radiographic series, all lesions enhanced after gadolinium, and all were hypointense on gradient echo sequences. Thirty-three percent were hypointense on T1-weighted pre-contrast imaging (95 % CI, 0.2–0.51), 49 % were hyperintense on T2-weighted imaging (95 % CI, 0.31–0.72), and 74 % were hypointense on diffusion-weighted imaging (95 % CI, 0.5–1.0). Notably, 37 % were associated with a prominent draining vein (95 % CI, 0.21–0.6), and 11 % with a developmental venous anomaly (95 % CI, 0.04–0.25). Across four observational studies with 47 patients, there was no observed change in lesion morphology or hemorrhage in 65.7 patient-years of follow-up. Although the vast majority of CCTs are managed conservatively, we found ten cases of patients treated with surgical excision. We confirm that CCTs are a benevolent entity with a predilection for the pons. They have distinctive radiographic features including their lack of mass effect, consistent enhancement on T1-weighted sequences and hypointensity on gradient echo sequences, and common isointensity on pre-contrast T1-weighted and T2-weighted images. Management for these lesions has been nonoperative in almost all cases.