Cavernous Malformation (Cavernoma)
Cavernous malformations can cause seizures and brain bleeds. One Brain and Spine's Melbourne neurosurgeons provide expert assessment and surgical management of cavernomas.
What is a Cavernous Malformation?
A cavernous malformation (also called a cavernoma or cerebral cavernous malformation) is a cluster of abnormal blood vessels in the brain or spinal cord. These vessels are enlarged and contain slow-moving blood. Unlike normal brain tissue, there is no healthy tissue between them.
Cavernous malformations affect about 1 in 200 people. They are different from other vascular malformations because they are low-pressure and do not have direct connections to arteries. As a result, bleeding is usually small and often contained within the lesion.
Many cavernous malformations never cause symptoms. However, they can sometimes bleed, often more than once over time, leading to neurological symptoms depending on their location. They may also cause seizures.
What Causes Cavernous Malformations?
Cavernous malformations can occur in different ways:
- Sporadic (most common): Usually a single lesion with no family history. The exact cause is unknown.
- Familial (inherited): Can be passed down in families. It is caused by changes in the CCM1, CCM2, or CCM3 genes and is often associated with multiple lesions.
- Radiation-induced: May develop years after radiation treatment to the brain.
Symptoms of a Cavernous Malformation
Seizures
Seizures are the most common symptom of cavernous malformations in the brain. They occur in about 40–50% of people who develop symptoms. Blood breakdown products from previous small bleeds can irritate the surrounding brain tissue and trigger seizures.
Focal Neurological Deficit
Bleeding from a cavernous malformation can cause sudden neurological symptoms. These depend on the location of the lesion and may include weakness, difficulty speaking, vision problems, or numbness. Cavernous malformations in the brainstem are particularly serious, as even a small bleed can cause significant problems.
Headache
Headaches may occur suddenly with a bleed or develop gradually due to repeated small bleeds.
Incidental Discovery
Many cavernous malformations are found incidentally when a brain scan is performed for another reason. They have a characteristic appearance on MRI, and the diagnosis can usually be made based on these imaging features.
How is a Cavernous Malformation Diagnosed?
- MRI scan: This is the most sensitive test for detecting cavernous malformations and can identify even very small lesions. They typically appear as a “popcorn-like” lesion with a dark rim caused by old blood.
Genetic testing may be recommended if multiple lesions are present or there is a family history. This is usually done as part of genetic counselling.
Treatment Options for Cavernous Malformations
Observation
Cavernous malformations that are not causing symptoms are often monitored with regular MRI scans. The risk of bleeding in these cases is low (about 0.5% per year). If seizures occur, anti-epileptic medication is usually started. Lesions located deep in the brain or in the brainstem are often observed initially, as surgery in these areas carries higher risk.
Surgical Resection
Surgery may be recommended if the lesion has caused bleeding and symptoms, is causing seizures that are difficult to control, or is in a location that can be safely reached.
Complete removal of the lesion is usually curative, although new lesions can develop in familial cases. Surgery eliminates the risk of further bleeding and often improves or resolves seizures.
At One Brain and Spine, our neurosurgeons use advanced techniques including intraoperative navigation, neuromonitoring, and microsurgery to maximise safety.
Stereotactic Radiosurgery
The role of radiosurgery is uncertain. It may be considered in selected cases, particularly for lesions deep in the brain or brainstem that have bled multiple times and cannot be safely removed with surgery.
Anti-Epileptic Medication
Anti-epileptic drugs are used to control seizures. If seizures continue despite medication, surgery may be considered if the lesion is in a suitable location.
Frequently Asked Questions — Cavernous Malformation Melbourne
Is a cavernous malformation the same as an AVM?
No. AVMs are high-pressure connections between arteries and veins and are visible on angiography. Cavernous malformations are low-pressure clusters of small vessels and usually do not appear on angiograms. They behave differently and are treated differently.
Can a cavernous malformation be hereditary?
Yes. About 20–40% of cases are inherited and linked to CCM1, CCM2, or CCM3 genes. These cases are often associated with multiple lesions.
What is the risk of a cavernous malformation bleeding?
The risk is low (about 0.5–1% per year) for lesions that have not caused symptoms. The risk is higher if there has been a previous bleed.
If I have a cavernous malformation, do I need surgery?
Not always. Many cavernous malformations can be safely monitored. Surgery may be recommended if there are symptomatic bleeds, difficult-to-control seizures, or worsening neurological symptoms.
Why Choose One Brain and Spine for Cavernous Malformation in Melbourne?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, bringing together extensive expertise in brain, spinal, and peripheral nerve surgery. Our team has particular strength in cerebrovascular neurosurgery, delivering multidisciplinary care using the latest technology available in Australia. We are committed to providing comprehensive, patient-focused treatment through:
- Specialist cerebrovascular neurosurgeons — internationally fellowship-trained with subspecialty cranial and cerebrovascular surgery expertise
- Advanced technology — including intraoperative navigation, neuromonitoring, and state-of-the-art microsurgical techniques
- Multidisciplinary care — close collaboration with neurologists, neurointerventionalists and radiation oncologists to ensure optimal outcomes
- Patient-centred approach — compassionate care with clear explanations of your diagnosis and all available treatment options
- All major health funds accepted