Cavernoma (Cerebral Cavernous Malformation)
A cavernoma is a vascular malformation of the brain or spinal cord made up of thin-walled, dilated vascular spaces. It is usually benign but can cause symptoms such as bleeding or seizures.
Ostatnia aktualizacja: 2026-06-06
Definition
A cerebral cavernous malformation (cavernoma) is a lesion composed of dilated, thin-walled capillary-like spaces with no intervening normal brain tissue. On imaging it is often described as having a 'mulberry' or 'popcorn' appearance. It may be single (sporadic) or familial and multifocal.
Causes and Risk Factors
Lesions may be sporadic or hereditary (autosomal dominant; associated with the CCM1/KRIT1, CCM2 and CCM3 genes). The familial form tends to produce multiple lesions. Some cavernomas may develop after previous brain radiotherapy.
Symptoms
Many cavernomas are asymptomatic and found incidentally. When symptomatic, the most common features are seizures, lesional hemorrhage and focal neurological signs (weakness, sensory loss, balance problems) depending on location. Brainstem cavernomas can cause prominent symptoms even with small bleeds.
Diagnosis
Magnetic resonance imaging (MRI) is the key modality; gradient-echo and SWI sequences in particular sensitively reveal small lesions and traces of prior hemorrhage. Because cavernomas are low-flow, they are usually not visible on conventional catheter angiography ('angiographically occult').
Treatment
For asymptomatic cavernomas, imaging surveillance is often preferred. For recurrent hemorrhage, drug-resistant seizures or progressive deficit, microsurgical removal is considered for accessible lesions. In high-risk areas such as the brainstem, the decision is individualized by balancing bleeding risk against surgical risk.
Prognosis
Many cavernomas remain silent; bleeding risk varies with lesion location, prior hemorrhage and the familial form. In appropriately selected surgical cases, complete removal reduces the risk of rebleeding. Outcomes vary from patient to patient and are not guaranteed.
Źródła
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1524-1530.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:4022-4028.
- Akers A, et al. Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations. Neurosurgery. 2017.
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