Cavernous Malformations

Treatment

There are three main treatment options for cavernous malformations (all are available at all three Mayo Clinics): observation, surgery and stereotactic radiosurgery.

Observation

The first treatment option is to observe the cavernous malformation with yearly MRI scans to see if it changes. This option may be indicated if the lesion is discovered incidentally and not thought to cause any problems.

Unfortunately, no one can predict what will happen with a cavernous malformation. Some will cause repeated hemorrhages with worsening symptoms such as headaches, seizures, difficulty speaking, vision problems or weakness in the arms or legs, while others remain inactive and do not cause symptoms for years.

The frequency of bleeding may depend on whether the malformation has previously hemorrhaged or caused symptoms. In some patients with cavernous malformations, the bleeding rate for those with no prior symptoms was 0.6 percent compared to 4.5 percent if there were previous symptoms. The average age when cavernous malformations first cause symptoms seems to be from 30 to 40.

If a person has had multiple bleeding episodes for a short time and symptoms are worsening, immediate evaluation and treatment are recommended.

Experts at Mayo Clinic do not recommend that relatives of a patient with a cavernous malformation undergo MRI scanning for a malformation unless more than one family member has been affected. In that case, an MRI may be worthwhile, but even this is somewhat controversial.

Surgery

Surgery is the most common treatment option when treatment is necessary. Because these malformations are so distinct from the surrounding brain tissue, cavernous malformations often can be completely removed without causing new problems. It is very important to remove the entire malformation because it can grow back if a small piece is left behind. The risk of the operation depends on the size and location of the cavernous malformation and the general health of the patient.

Stereotactic Radiosurgery

This procedure, which involves one treatment of very focused radiation to the cavernous malformation, is another option. In the past, this treatment has been used almost exclusively for lesions causing repeated hemorrhages in areas of the brain that are not surgically accessible.

It is often hard to determine if the radiosurgery has been effective unless the lesion never bleeds again. In certain cases, radiosurgery has likely decreased the repeat hemorrhage rate; however, radiosurgery has never been shown to completely eliminate the malformation. Read more about stereotactic radiosurgery.