Cavernous Malformations

Treatment

The main treatment options for cavernous malformations are observation and surgery. In rare instances, patients may benefit from stereotactic radiosurgery. A team of cerebrovascular specialists (neurologists, neurosurgeons, neuroradiologists) discuss treatment options with patients and their families and jointly decide the best treatment plan.

Observation

The first treatment option is to monitor the cavernous malformation with yearly MRI scans to see if it changes. This is an option for malformations discovered during testing for other diseases, and which are not causing problems.

No one can predict what will happen with a cavernous malformation. Some cause repeated hemorrhages with worsening symptoms such as headaches, seizures, difficulty speaking, vision problems or weakness in the arms or legs. 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 for those with previous symptoms. The average age when cavernous malformations first cause symptoms seems to be from 30 to 40.

If a patient is not experiencing symptoms from the malformation, then an MRI should be performed every one to two years to monitor the condition's status. However, if the patient is experiencing symptoms from a malformation which is surgically accessible, then surgery often will be recommended. If the malformation is difficult to access (with higher risks of injury from surgery), the physician may recommend continued observation and surgery only if the patient has multiple bleeding episodes or worsening symptoms.

Surgery

If treatment is necessary, surgery is the most common option. Because they 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

Stereotactic radiosurgery may be considered for a small subset of patients whose cavernomas are causing repeated hemorrhages in areas of the brain that are not surgically accessible. In certain cases, radiosurgery — one treatment of very focused radiation — has likely decreased the repeat hemorrhage rate; however, radiosurgery has not been shown to completely eliminate malformations.