Cavernous Malformations of the Brain: Natural History and Surgical Outcomes

Abstract

Cerebral cavernous malformations (CCM) are rare, benign
vascular anomalies of the central nervous system with a
prevalence of 0.5–0.8%. While often discovered
incidentally, they may present with seizures, headaches,
focal neurological deficits, or intracranial haemorrhage.
Sporadic cases typically involve solitary lesions, whereas
familial forms are associated with multiple lesions and
genetic mutations such as PDCD10. Supratentorial
locations predominate, but brainstem, cerebellar, and
spinal involvement are also observed.
Management depends on symptomatology and lesion site.
Asymptomatic cases are generally observed with serial
imaging, while symptomatic lesions may require
intervention. Microsurgical resection remains the
treatment of choice for patients with medically refractory
seizures or recurrent haemorrhage, offering favourable
long-term outcomes and high seizure control rates.
Radiosurgery may be considered for deep or eloquent
lesions where open surgery carries a higher risk, though its
benefits are delayed. An individualized approach is
essential to optimize neurological and functional outcomes
in CCM.
Keywords: Cavernoma, Cavernous malformation, Seizure,
ICH, Microsurgery, Radiosurgery