A cavernous malformation diagnosis can be frightening.
This is where we can help. Barrow Neurological Institute neurosurgeons are internationally renowned for their expertise in cavernous malformation treatment and rise to meet the most challenging cases from all over the world.
Get Your Cavernous Malformation Second Opinion Online
A cavernous malformation has many names—cavernoma, occult vascular malformation, cavernous angioma, cavernous hemangioma. Have your case reviewed by our experts in cavernous malformation surgery and receive valuable guidance through our fast, easy, and affordable Barrow Second Opinion program.
Our neurosurgeons have treated thousands of cavernous malformations—many in deep and challenging areas of the brain. Through Barrow Second Opinion, we can recommend the best course of treatment its size and location, whether it’s open surgery, endovascular surgery, or radiosurgery.
Before, during, and after your cavernous malformation treatment, you can be certain that you are in the hands of the most dedicated and experienced specialists for cerebral cavernous malformations. Our experts are committed to learning more about the causes of cavernous malformations and what makes them bleed.
It matters where you get your care. As one of the busiest, and highest ranked, neurosurgical centers globally, our neurosurgeons operate on the toughest and rarest conditions. With more than 6,000 surgeries performed annually and thousands of cavernous malformations treated surgically, the high volume at Barrow leads to more experience and better outcomes for our patients. We treat all kinds of cavernous malformations at Barrow, including:
Brainstem Cavernous Malformations
Cerebellar Cavernous Malformations
Cerebral Cavernous Malformations
Spinal Cavernous Malformations
About Cavernous Malformations
Cavernous Malformation Overview
A cavernous malformation is a cluster of dilated blood vessels (capillaries) with an enlarged and irregular structure. The walls of these capillaries are thinner than normal, have loose junctions between cells, and are prone to leaking.
These abnormalities can occur anywhere in the body, but they are most likely to produce symptoms when they form in the brain or spinal cord. They can cause neurological symptoms when they bleed into the brain (hemorrhage).
This illustration shows the normal brainstem on the left and a cavernous malformation in the brainstem on the right. In the image on the right, the cavernous malformation is displacing the nerves of the spinothalamic tract. These nerves are responsible for relaying signals for temperature, pain, and touch from the body to the brain.
The severity of a cavernous malformation depends on two variables:
Where it is located in the brain
Its size, or how big it is
If it is in a critical spot, like the brainstem, a cavernous malformation is quite serious because any hemorrhage will impact a vital tract, nucleus, or circuit and can cause paralysis, breathing problems, or other neurological deficits. Large cavernous malformations are more likely to touch on an eloquent or critical structure. These can cause issues with speech, movement, or cognition.
The average size of a cavernous malformation is around one centimeter, or about half an inch. A cavernous malformation is considered giant if it is three centimeters or larger, or over an inch in diameter.
Synonyms for Cavernous Malformations
There are several other terms that describe cavernous malformations, including:
Cerebral cavernous malformation (CCM)
Cavernoma
Cavernous angioma
Cavernous hemangioma
Conversely, these lesions are not considered brain tumors.
A brain tumor is a neoplastic lesion where some cells divide and the mass is constantly growing, whereas cavernous malformations are an abnormal assembly of the normal vascular cells that can leak blood. This cluster of abnormally assembled cells will basically stay the same if left alone, and it only grows when it bleeds. The blood and fluid that accumulates can make it grow, but it is not the same as a tumor with cells that are dividing and growing in number.
Anatomy of the Cerebrovascular System
The cerebrovascular system is the network of blood vessels that supply your brain with oxygen and nutrients. The system includes the internal carotid arteries, vertebral arteries, and their branches, which bring blood into the brain, and the veins that carry blood out of the brain.
The carotid arteries are located in the neck and provide blood to the front part of the brain (known as the anterior circulation). The vertebral arteries are located at the back of the neck and provide blood to the back part of the brain (the posterior circulation). These arteries branch off into smaller blood vessels, which then supply different areas of the brain.
Within the brain, the smallest blood vessels are called capillaries, which have thin walls that allow for the exchange of oxygen and nutrients with brain cells. The capillaries then join together to form larger blood vessels called veins, which carry the blood back to the heart to be reoxygenated via the internal jugular veins. As mentioned above, cavernous malformations in the brain are part of this capillary network and contain dilated, enlarged, and weak vessels, that are prone to bleeding.
The cerebrovascular system is essential for the proper functioning of the brain. Any disruption of blood flow to the brain can cause serious health problems, such as stroke or cognitive impairment. Therefore, maintaining a healthy lifestyle and managing risk factors such as high blood pressure or diabetes is important for maintaining the health of the cerebrovascular system.
Cavernous Malformation Symptoms
When a cavernous malformation leaks, bleeding can be slow and intermittent or rapid, causing sudden symptom onset. Most people who develop neurological deficits after a hemorrhage improve dramatically over time. However, repeated hemorrhages may result in permanent neurological problems.
It is not common for cerebral cavernous malformations to cause fatigue.
Illustration of a cavernous malformation (cavernoma) in the peritrigeminal pontine region. The nerve tracts are color coded to correspond to the symptoms they cause in different parts of the body.
Cavernous Malformation Treatments
If you are diagnosed but not experiencing symptoms, your doctor may recommend observing the malformation over time with regular MRI scans.
Medications, such as anti-epileptic drugs, may be prescribed to control your seizures or other symptoms.
Cavernous Malformation Surgery
If your symptoms are not responding to medication or there is repeated bleeding in the brain, surgical removal may be recommended.
This illustration shows a cavernous malformation in the brain stem and the best path, denoted by a blue line, for the neurosurgeon to access and remove it. The cavernous malformation is the purple-colored, berry-like structure in the lower right portion of the brain stem.
Not all cerebral cavernous malformations need to be removed surgically. If it has not bled before, then there is approximately a 1-4% chance each year that it will hemorrhage.
Conversely, cavernomas that have bled before have a higher chance of bleeding again in a given year. A cavernous malformation that shows behavior suggesting it is more likely to continue to bleed and cause harm should be removed. If a lesion is quiet and behaving well, then it is sometimes best left alone.
Cavernous malformations can be cured by complete surgical removal.
Additional Information
How common are cavernous malformations?
About one person in every 100 to 200 people has a cerebral cavernous malformation, but about 25 percent of people affected never have symptoms.
Who gets cavernous malformations?
These lesions can affect children and adults. Most people who have symptoms are between 20 and 50 years old.
Most occur without any single identifiable cause, but in some cases they can be inherited genetically from your mother or father.
How are cavernous malformations diagnosed?
Cerebral cavernous malformations are mainly diagnosed by magnetic resonance imaging (MRI). They have a telltale characteristic appearance on MRI.
An MRI showing a cavernous malformation in the brain denoted by the red arrows.
Are cavernous malformations life-threatening?
These lesions usually are not life-threatening, but repeated bleeds may cause permanent neurological deficits. Malformations in sensitive tissue like the brainstem and thalamus can be extremely disabling if they bleed.
Do cavernous malformations go away?
They do not go away without surgical removal. However, they may go dormant and stop bleeding. It is difficult to predict which lesions will bleed again and when.
Is a cavernous malformation a tumor?
These lesions are better described as abnormally formed blood vessels. They are not tumors in the sense of multiplying cells and growing tissue. They do not spread to other parts of the body and infiltrate organs like cancerous tumors.
Are cavernous malformations hereditary?
Most of cavernous malformations are classified as sporadic cavernous malformations, meaning there is no known family history of the disease. However, 15 percent are caused by inherited genetic mutations. There are known as familial cavernous malformations.
Can a cavernous malformation cause memory loss?
Yes, a cavernous malformation can cause memory loss if it is located in, or nearby, the part of the brain that controls memory.
What is the difference between a cavernous malformation and an aneurysm?
An aneurysm is a sac or balloon-like outpouching on the artery in the brain that can burst and result in high-pressure bleeding, whereas cavernous malformations are abnormally assembled capillaries and veins that have a low-pressure leakage, or ooze. An aneurysm is arterial; a cavernous malformation is capillary and venous, so they have a very different bleeding profile.
Can COVID-19 cause a cavernous malformation?
COVID-19 does not cause a cavernous malformations.
Is there a difference between a cavernoma and a cavernous malformation?
There is no difference between a cavernoma and a cavernous malformation. These terms describe the same condition.
Can you take ibuprofen with a cavernous malformation?
Yes, you can take ibuprofen with a cavernous malformation. While ibuprofen is a blood thinner, it will not cause it to bleed, or make it bleed more frequently.
However, if a cavernous malformation were to bleed while a person is taking ibuprofen, it might bleed slightly more because the platelets (the cell fragments in your blood that promote clot formation) are slightly inhibited.
Can you drive with a cavernous malformation?
It is possible to drive if you have a cavernous malformation. However, some patients with a cavernous malformation have seizures. If you have experienced a seizure that has been reported to the department of motor vehicles (DMV) or a similar regulatory agency, your license usually will be suspended for six months. A person must show that they have been seizure free for six months before their driver’s license can be reinstated. Seizures can typically be controlled by taking an anticonvulsive medication.
By and large, seizure-producing cavernous malformations are located in the cerebrum. Cavernous malformations in the brainstem or cerebellum don’t produce seizures and tend not to be a driving risk.
Can you exercise with a cavernous malformation?
Yes, you can exercise with a cavernous malformation.
Are there activities you should avoid with a cavernous malformation?
No, there are no activities you should avoid if you have been diagnosed with a cavernous malformation. You may have been told that you shouldn’t lift heavy weights, as it somehow predisposes your cavernoma to bleeding, but there is no evidence for that.
Can some things make you more likely to have a cavernous malformation?
A cavernous malformation is a random event. While some cavernous malformations can be caused by a genetic disposition, most are sporadic and not caused by anything under your control.
Frequently Asked Questions
How much does it cost?
The cost for a second opinion from a top neurosurgeon at Barrow Neurological Institute is a flat $100, and it is non-refundable. Payment must be made by credit card at the time of submission. We do not offer other payment options at this time.
How does it work?
Once you click the link, you’ll be directed to our Dignity Health hello humankindness secure portal where you will create your account.
You will answer an electronic questionnaire to give our physicians an understanding of your medical history and the condition you would like an opinion for.
After filling out our questionnaire, we’ll direct you to a secure page where you can upload your MRI and/or CT images.
Payment will be requested.
Once payment is received, your case will be sent to a coordinator who will review all of your information. The coordinator may contact you for additional information.
After the coordinator confirms that all of the information the neurosurgeon will need to review your case has been met, your case will be routed to the neurosurgeon most appropriate for your condition.
Within 7 to-10 business days, you’ll receive a notification through email that your second opinion is available in the portal. (Please note 7 to 10 business days cannot be guaranteed for submissions from June through August, peak summer months, and submissions during the peak U.S. holiday months of November and December; To ensure that our physicians have the most up-to-date information about your case, Barrow Second Opinion requires that your most recent imaging tests be performed within the last six months. We get it: Imaging scans are inconvenient and sometimes uncomfortable. But the more current your imaging is, the more meaningful your second opinion will be!)
You may download, keep, and share your second opinion with whomever you like.
Why should I get a second opinion from Barrow Neurological Institute?
Barrow Neurological Institute is one of the leading neurosurgical teaching hospitals in the world and has been designated as a top neurosurgery hospital by Newsweek. Patients and healthcare providers come from across the globe to receive care and learn from us. We acknowledge that many areas do not have the expertise we do and understand cost can be a large barrier to care. Our Second Opinion Program can help connect you digitally to a top neurosurgeon even if they aren’t any practicing in your immediate area.
Do I need to travel to Barrow Neurological Institute for treatment?
There is no obligation for you to come to Barrow Neurological Institute for treatment, and your second opinion is yours to keep and share.
What if I decide to come to Barrow Neurological Institute for treatment?
If your second opinion recommends neurosurgery and you decide to come to Barrow Neurological Institute for treatment, you will be treated by the neurosurgeon who reviewed your case. If you decide to come to Barrow, simply let our Second Opinion Program coordinators know. Our coordinators will assist you with appointment scheduling, travel resources, insurance verification, and financial concerns.
Can I submit anything I want?
No. There are a few rules:
You must have been diagnosed with one of the conditions outlined in the second frequently asked question.
Your imaging must be related to your condition, meet requested requirements, and have been taken in the past six months.
You must have already been diagnosed by a physician for the condition that has been submitted. We are unable to provide an initial diagnosis of your condition.
All records and information must be submitted in English, as Barrow Neurological Institute cannot translate these materials.
How old do I have to be?
You must be 18 years of age or older to submit your request for a neurosurgical second opinion.
May I submit a case for my child?
You may submit a case for a child as long as the child is 14 years of age or older. We may make some exceptions based on special situations; please email your inquiries to BarrowSecondOpinion@DignityHealth.org.
How long does this process take?
Once you have submitted the required documentation and imaging, your second opinion will be available in 7 to 10 business days. Please note that 7 to 10 business days cannot be guaranteed for submissions during November and December; peak U.S. holiday months, and the peak summer months of June through August.
Will you be contacting my doctor?
No. We will not contact your physician. We do recommend, however, that you share the recommendation with your doctor so that they are still involved in your care.
Is the Second Opinion program covered by my insurance?
Although you may need to contact your insurance carrier for more information, we do not bill insurance companies for participating in our Second Opinion Program. You will be responsible for submitting any requests to your insurance company for reimbursement.
Please note that motor vehicle accident and workman’s compensation cases may not be able to be processed through our Second Opinion Program.
Does this make me a patient at Barrow Neurological Institute?
No. Receiving a neurosurgical second opinion does not make you a patient of Barrow Neurological Institute. In order to become a patient, you must make an appointment and be seen in our offices. If you’ve received a neurosurgical second opinion and would like to be seen at Barrow Neurological Institute, please call us at (602) 406-3396.
How it Works
Get Your Second Opinion in 4 Steps
Getting a second opinion from one of the best neurosurgeons in the United States is fast, easy, and secure. It’s also affordable: we offer our neurosurgical second opinions for a flat, non-refundable fee of $100paid upfront.
Here’s how it works:
Step 1: Tell us about yourself To get started, you’ll need to create an account with your contact information to use our secure Second Opinion Portal. Once your account is set up, we’ll ask you to tell us about your diagnosis, symptoms, and medical history in a brief questionnaire. Please remember, our doctors can only base your second opinion on the information and diagnostic imaging you provide. We’ll protect your personal health information like we would with any Barrow patient. Please note: Your Second Opinion Portal is operated through a Dignity Health hello humankindness account.
Step 2: Upload your medical images After filling out our questionnaire, we’ll direct you to a secure page where you can upload your MRI and/or CT images. Rest assured, we’ll only share these images with our neurosurgeons and clinical staff.
Step 3: Submit payment We require a payment of $100 to process a request. We accept Visa or Mastercard.
Step 4: Get your second opinion in 7-10 business days (or less) After we receive your request, we’ll assign your case to a neurosurgeon who specializes in your diagnosis.
What to Expect from The Barrow Second Opinion Program
You can expect to receive your second opinion within 7 to 10 business days from the time we receive all required documentation and diagnostic imaging. We’ll contact you if any information is missing. (Please note that 7 to 10 business days cannot be guaranteed for submissions during November and December; peak U.S. holiday months, and the peak summer months of June through August.) Once our neurosurgeon makes a recommendation, we’ll notify you by e-mail that your second opinion is ready. You can log into your account and view the report in a PDF format.
You’re not obligated to pursue our recommended course of treatment at Barrow or any other institution. However, if our neurosurgeon recommends surgery, we’ll provide their contact information so you can schedule a consultation if you choose.
Finally, our Second Opinion Program is not meant to replace an in-depth, face-to-face consultation with a physician.
