Cavernous Malformation of the Brain (Cavernous Angioma; Cavernoma)
Cavernous malformations are clusters of abnormal, tiny blood vessels, and larger, stretched-out, thin-walled blood vessels in the brain that are filled with blood. These malformations can also occur in the spinal cord, the covering of the brain (dura), or the nerves of the skull. Cavernous malformations range in size from less than one-quarter inch to 3-4 inches.
The exact cause of a cavernous malformation is not totally understood however genetics may play a role. Some individuals are born with a tendency to develop cavernous malformations. If multiple family members have seizure disorders or associated blood vessel abnormalities on the skin, other family members may be at higher risk of a cavernous malformation. The malformation results when small blood vessels (capillaries) within the brain mass or its coverings aggregate into enlarged or irregular masses. Compared to other blood vessels, capillaries have thin walls and lack supportive and stretchy tissue. When they stretch out or malform from excessive blood flow, they often cannot return to their normal size. They are not a cancer, which means they cannot spread to other parts of the body. Occasionally, people can have multiple cavernomas.
Some people with cavernous malformations may not experience any symptoms at all. When symptoms do occur, the type of neurological deficit are usually related to the location of the brain or spinal cord in which they occur. Symptoms may appear and subside as the cavernous malformation changes in size due to bleeding and reabsorption of blood. Any of the following symptoms may occur:
- Weakness in arms or legs
- Vision problems
- Balance problems
- Memory and attention problems
The primary step with any diagnosis is for your doctor to obtain a complete health history including any family health history that may be pertinent to your diagnosis. Because a cavernous malformation may not be visible on an angiogram, your physician will most likely order an MRI with and without contrast to identify and locate the area of the malformation as well as detect its size, recent bleeds or appearance of new malformations.
Many people can go their entire lives living with a cavernous malformation and not know it or have no symptoms. In asymptomatic patients the malformation may be incidentally discovered. In these types of cases monitoring may be the only treatment necessary with MRI scans being performed annually for two years and then every five years there after. Some people may be prescribed anti-convulsant medications.
For patients with symptomatic malformations surgery may be considered, however there are many factors when considering surgery. Any surgery of this type should be performed by a experienced neurosurgeon. Your neurosurgeon will evaluate each case on an individual basis and determine whether or not symptoms or seizures can be controlled through medication; if the malformation is in a low risk, easily accessible area of the brain and it has been determined that the lesion is causing the seizures. Other considerations are whether or not the surgery itself will cause neurological deficits, number of malformations, severity and recurrence of cavernous malformation symptoms, etc.
Our experts at SCCNS will help each individual understand their condition and will assist is helping then choose the treatment course that will best benefit them.