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Cavernous Malformations

What is a Cavernous Malformation?

A vascular malformation is an abnormal collection or tangle of blood vessels. The malformations, which usually are genetic in origin, restrict or alter blood flow and are associated with the degeneration of neurons.

Cavernous malformations are characterized by a number of different blood-filled sacs, chambers, and channels with thin walls and containing blood of various ages, some of which is clotted and some of which is not. These malformations tend to push brain tissue aside rather than involve it, as some other malformations may do. Cavernous malformations can occur in any part of the brain and in the spinal cord, brain stem, and optic nerve, and they may grow slowly with time.

Symptoms

Cavernous malformations can cause a variety of symptoms, including seizures, headache, and neurological deficits. In addition, cavernous malformations are associated with a risk of bleeding, or hemorrhage. Because the malformation develops separate pockets, it may bleed small amounts at a time. Larger hemorrhages are serious neurological emergencies and can cause critical neurological problems.

Diagnosis

Magnetic resonance imaging (MRI) scans are the most useful diagnostic study for cavernous malformations. In addition, computed tomography scans and angiography, which provides an image of the blood flow in the brain, may be used. However, angiography rarely is required.

Treatment

The decision to treat a cavernous malformation depends on whether it causes symptoms and the condition of the patient. Sometimes a cavernous malformation may not need treatment and will be observed with regular MRI scans. In cases of large or symptomatic cavernous malformations, or malformations with recurrent hemorrhages, surgery to remove the malformation can be used. Because these malformations tend to appear separate from other structures, they usually can be removed successfully with microsurgical techniques. Stereotactic radiosurgery (highly targeted radiation therapy) may be indicated in rare cases.

Cavernous malformations are complex lesions, and should be addressed at major centers with experts experienced in their treatment.

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