What is a cavernous malformation?

A cavernous malformation, also known as a cavernoma, is a blood vessel malformation that can occur in various organs, including the brain and spinal cord. A cavernoma consists of a small network of tiny, thin-walled blood vessels called capillaries. Cavernomas are of medical significance because they can bleed without warning.

Below is an example of a cavernoma in the temporal lobe.

What are the symptoms?

Cavernomas can cause symptoms when they bleed. Capillaries are low-pressure blood vessels, so, most of the time, the amount of bleeding is small. But there are certain places in the nervous system where even a small amount of bleeding can be serious.

Symptoms depend on the location of the cavernoma but can include weakness, numbness, headaches, problems with vision or speech, and seizures. Symptoms may improve over time as the blood gets absorbed, but patients can sometimes be left with permanent neurologic problems.

Patients with cavernomas may in some cases develop recurrent seizures, a condition referred to as epilepsy.

How are cavernous malformations treated?

There are not effective medications for cavernomas. They are generally treated with one of several surgeries, described below. Not all cavernomas need treatment, however. Cavernomas that are discovered incidentally and are not causing symptoms or that are in relatively "quiet" regions in the brain can often just be observed - especially in patients for whom surgery would be risky.

Traditionally, cavernomas have been removed by a craniotomy. This procedure involves opening the skull, identifying the cavernoma under a microscope, and removing it. Craniotomy remains an excellent treatment for cavernomas that are located in accessible parts of the brain.

Treating cavernomas in deep areas of the brain can be more challening. Reaching deep cavernomas with a craniotomy may be risky in certain cases. For such deeper locations, or for patients wishing to avoid a craniotomy, two less invasive therapies can be considered: laser interstitial thermal therapy (laser ablation) and radiosurgery.

Deciding between these three options (or whether to treat your cavernoma at all) will involve a detailed discussion with your doctor about your symptoms, medical history, and the location of the cavernoma.