Definition

Also known as: cavernous angiomas, cavernous hemangiomas, or cavernomas.

Cavernous malformations are abnormal groupings of the small blood vessels. Cavernous malformations can be found in many locations in the body, but those in the brain or spinal cord have the greatest potential for causing serious problems. The clustering has a distinctive appearance under magnetic resonance imaging (MRI) and the microscope.

Cavernous malformations are generally present at birth but may develop later in life. They can enlarge and bleed over time, or they may remain silent throughout a patient's lifetime.


Preoperative MRI Demonstrating left frontal cavernous malformations with areas of recent hemorrhage

Causes

These malformations tend to be sporadic, but they do run in some families (about 20 percent of all cavernous malformations), especially those of Hispanic descent. They occur equally in men and women. Cavernous malformations may form at any age but patients typically present with symptoms around 20-30 years of age.

Risks

Risk factors are things associated with an increased chance of developing a disease or condition. There are no known risk factors for the development of cavernous malformations.

However, the main risk from cavernous malformation is bleeding. The abnormal blood vessels of cavernous malformations are pathologically thinner, weaker, and less elastic than normal capillaries. Small amounts of bleeding into the cavernous malformation are common. Larger bleeds usually cause symptoms and indicate a need for treatment to prevent further hemorrhage. Factors thought to increase the risk of rupture are:

  • Prior bleeding from cavernous malformations
  • Number of cavernous malformations (more increases the risk)
  • Size and location of the cavernous malformation

Symptoms

Many people with cavernous malformations are asymptomatic.  About one third with cavernous malformations may develop symptoms during their lifetime. Symptoms depend on where the lesion is located. Common symptoms are:

  • Headache
  • Seizures
  • Sudden weakness
  • Balance problems
  • Visual problems
  • Memory problems
  • Speech difficulty

Diagnosis

Doctors generally diagnose cavernous malformations after patients present with symptoms. Your doctor will take a medical history and order additional tests, including:

  • MRI
  • CT and/or CT angiography
  • Catheter angiography, usually performed to rule out other pathology because cavernous malformations are not visible on angiograms

Treatment

The objectives of treatment are to prevent bleeding, to reduce pressure on the brain caused by the lesion, or to treat seizures or other symptoms caused by the lesion. The decision to treat or not to treat depends on the size and location of lesion, whether it is causing any symptoms, and if it has already bled.

Treatment options include:

  • Observation and medical management of symptoms
  • Surgery, usually using computer-aided navigation, is curative and safe in the majority of cases
  • Radiosurgery is sometimes an option for lesions that are difficult to reach


Intraoperative view of frontal lobe showing discoloration of the brain surface due to the recent hemorrhage.

Intraoperative view demonstrating removal of the CM in progress. The arrows indicate areas of dilated abnormal blood vessel structures containing blood.

Prevention

There is no known method to prevent the formation of cavernous malformations. The risk of bleeding can be somewhat modified by:

  • Surgical treatment
  • Radiosurgery


Postoperative MRI after resection of the cavernous malformation that shows complete removal of the lesion and the associated hemorrhage

If you want to learn more about cavernous malformations and their treatment, call the Mount Sinai Department of Neurosurgery at 212-241-2377.

Images used with permission from Joshua B. Bederson, MD

Content provided by the Mount Sinai Department of Neurosurgery.

This information is provided to supplement the care provided by your physician. Mount Sinai does not intend or imply this content to be a substitute for professional medical advice. Call you health care provider immediately if you think you may have a medical emergency. Always seek the advice of your physician or other qualified health provider before starting any new treatment or with any questions you may have regarding a medical condition.