Cavernous Malformation

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).

The severity of a cavernous malformation depends on two variables: 

1. Where it is located in the brain 
2. 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.

In This Article

1. Overview
2. Symptoms
3. Treatments
4. Resources
5. Videos
6. Patient Stories
7. References

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.

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.