Cavernous Malformation

A cavernous malformation, also known as a cavernoma, is a blood vessel malformation that can occur in various organs, including the brain. 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.

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. Treating the cavernoma early can help prevent the development of drug-resistant seizures.

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.

If you are considering or planning a craniotomy, my guide for patients having a craniotomy for brain tumor/lesion explains how to prepare and what to expect before and after surgery.

Treating cavernomas in deep areas of the brain can be more challenging. 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.

If you live near Denver and have a brain cavernoma, please consider meeting me in consultation to learn about treatment options. You can also review my craniotomy guide for patients.