What is a Cavernous Malformation?

A cavernous malformation, also called a cerebral cavernous malformation, cavernoma, cavernous angioma, or CCM, is a cluster of abnormal small blood vessels in the brain or spinal cord. These vessels have thin walls and slow blood flow, which makes cavernous malformations different from high-flow vascular lesions such as arteriovenous malformations.

Some cavernous malformations are found incidentally on MRI and never cause symptoms. Others may cause seizures, headaches, neurological symptoms, or bleeding in the brain, also called intracerebral hemorrhage. Symptoms depend on the malformation’s size, location, bleeding history, and whether it affects nearby brain or spinal cord tissue.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed cavernous malformations to help determine the appropriate next step. Evaluation may include neurological examination, MRI review, assessment for prior hemorrhage, seizure evaluation, genetic counseling consideration in selected cases, monitoring, or neurosurgical treatment planning when appropriate.

Common Signs and Symptoms

Cavernous malformation symptoms depend on the location of the lesion, whether it has bled, and whether it is affecting nearby brain or spinal cord tissue. Some cavernous malformations do not cause symptoms.

Common signs and symptoms may include:

• Seizures
• Headaches
• Weakness, numbness, or tingling in the face, arm, or leg
• Trouble speaking, understanding speech, or finding words
• Vision changes, including blurred vision or double vision
• Balance problems, dizziness, or trouble walking
• Memory problems, confusion, or difficulty concentrating
• Facial numbness or cranial nerve symptoms when the lesion is near the brainstem
• Sudden neurological changes from bleeding, also called hemorrhage
• Neck, back, arm, or leg symptoms if a cavernous malformation involves the spinal cord

Seek emergency medical care or call 911 for a first-time seizure, sudden weakness, sudden speech difficulty, sudden vision loss, severe confusion, loss of consciousness, sudden severe headache, or rapidly worsening neurological symptoms.

What Causes This Condition?

The exact cause of many cavernous malformations is not clearly known. A cavernous malformation diagnosis does not usually mean that the patient did something to cause it.

Cavernous malformations may occur in different ways:

• Sporadic cavernous malformations, which usually occur as a single lesion without a known family history
• Familial cerebral cavernous malformation, an inherited form that may cause multiple lesions
• Genetic changes involving KRIT1/CCM1, CCM2, or PDCD10/CCM3 in some familial cases
• Association with a developmental venous anomaly, also called a DVA, in some sporadic cases
• Prior radiation exposure in selected cases

These are causes or risk-related factors, not guarantees that symptoms will occur. Treatment planning depends on the cavernous malformation’s location, symptoms, hemorrhage history, seizure history, imaging findings, family history, and the patient’s overall health.

How It Is Diagnosed?

A cavernous malformation cannot be diagnosed by symptoms alone. Diagnosis usually requires medical history, neurological examination, and imaging.

Common diagnostic steps may include:

• Medical history and neurological examination to evaluate seizures, headaches, strength, sensation, reflexes, vision, speech, balance, coordination, memory, and alertness
• MRI of the brain or spine with and without contrast, often the main imaging study used to evaluate cavernous malformations
• Susceptibility-weighted imaging, also called SWI, or gradient echo MRI sequences, which can help detect small blood products from prior bleeding
• CT scan of the head in urgent situations when bleeding or acute neurological symptoms are suspected
• Comparison with prior MRI or CT scans to determine whether the lesion is stable, changing, or associated with new bleeding
• Genetic counseling or genetic testing in selected cases, especially when there are multiple cavernous malformations or a family history
• Electroencephalogram, also called EEG, when seizures are part of the evaluation
• Catheter angiography only in selected cases, usually when another vascular condition needs to be ruled out, because cavernous malformations are often not visible on standard angiography

The goal of diagnosis is to confirm the lesion type, identify whether bleeding has occurred, understand whether symptoms match the cavernous malformation’s location, and determine whether observation or treatment should be considered.

Treatment Options

Cavernous malformation treatment depends on the lesion’s location, symptoms, bleeding history, seizure history, MRI findings, number of lesions, surgical risk, and the patient’s overall health. Not every cavernous malformation needs surgery.

Treatment options may include:

• Observation with repeat MRI scans for selected cavernous malformations that are not causing symptoms or have a lower-risk clinical pattern
• Medication for seizure control when seizures occur and are thought to be related to the cavernous malformation
• Medication for headache management when headaches are present and other causes have been considered
• Emergency evaluation and supportive care when bleeding causes sudden neurological symptoms
• Microsurgical resection when a cavernous malformation is causing symptoms, has bled, is surgically accessible, or is associated with seizures that are difficult to control
• Image-guided surgery to help plan the safest route to the cavernous malformation when surgery is appropriate
• Functional mapping or tractography in selected cases when the lesion is near important areas for movement, speech, vision, or sensation
• Stereotactic radiosurgery in selected cases when surgery is not ideal, although its role for cavernous malformations is more limited and requires careful specialist discussion
• Rehabilitation and supportive care to help with weakness, balance, speech, vision, cognition, or daily function when symptoms are present

Surgery may be considered when the cavernous malformation causes repeated bleeding, progressive neurological symptoms, difficult-to-control seizures, or pressure on important brain or spinal cord structures. The safest plan depends on the lesion’s location and whether treatment risk is lower than the risk of continued observation.