A cavernoma is a collection of small blood vessels in the brain that are enlarged and irregular in structure. Because they lack fibers that normally make them stretch, the blood vessels are prone to leakage (bleeding), which can cause a variety of symptoms including headaches and seizures. Some people have no symptoms but others with the disease may experience a severe brain hemorrhage.
Cavernomas are known by several other names including cavernous malformations, cerebral cavernous malformations (CCM), cavernous angioma, and cavernous hemangioma. The lesions are described as looking like raspberries or like popcorn. While cavernomas can occur anywhere in the body, they are typically of concern when they are located in the brain and spinal cord.
The lesions are localized collections that are not cancerous and can develop throughout one’s lifetime. Unlike other types of brain lesions, cavernomas do not contain brain tissue within the malformation. They can range in size from microscopic to several inches in diameter. Although these malformations are rare, they account for 8-15 % of all brain and spinal vascular malformations. As many as 40% of people who are affected will not experience symptoms or may never be diagnosed.
There are several types of cavernomas:
- Familial cavernous angioma is a hereditary form of the condition that typically shows up in one’s 20s or 30s. About a third of patients with this type will develop symptoms.
- Sporadic cavernous angioma is not inherited and may be present from birth or may develop later in life.
- Associated venous angioma is a type of cavernoma that develops near another lesion known as a venous angioma, which is a small tangle of abnormal veins.
Wellstar neurologists and neurosurgeons can diagnose cavernomas and, depending on their size and location, help patients determine the need for and type of treatment.
- At least 30% of people with a cavernoma will develop symptoms, while some experience no symptoms at all. When symptoms do occur they depend on the location of the lesion and on the strength or weakness of the walls and their propensity for bleeding.
- Seizure: (epileptic seizure) is the most common symptom. There are many types of seizures, ranging from mild to dramatic. The type of seizure depends on the location of the cavernoma.
- Neurological problems: Examples are weakness in the arms or legs and problems relating to vision, balance and/or memory and attention. The symptoms may come and go as the cavernoma changes.
- Bleeding: Cavernomas can bleed slowly within the walls of the lesion and remain quite small. If a small hemorrhage (bleed) occurs it may be reabsorbed into the body and not require treatment. Continued small hemorrhages in the same cavernoma can lead to deterioration in the function of the vessels. In a type of bleed known as an overt hemorrhage, the bleed may move through a weak spot in the wall and into surrounding brain tissue. The more cavernomas a patient has, the greater the chance of a bleed at some point.
- Headache: Headache typically occurs following a recent bleed
There are few known risk factors for cavernoma. The sporadic (non-hereditary) form of the disease occurs for no apparent reason. About 20% of cases are a familial (hereditary) form of the condition. Researchers have identified three different genes associated with cavernoma and are working to understand the relationship between these gene mutations and symptoms of the disease.
Some experts believe that prior radiation (for conditions including cancer) can be a risk factor for developing cavernoma. There is a higher rate of familial cavernoma among Hispanic-American families who originally came from New Mexico. And the condition is more likely to develop in the vicinity of the blood vessel malformation known as venous angioma.
There are no known ways to prevent cavernoma. Wellstar neurosurgeons/neurologists agree with specialists who recommend not smoking, maintaining a healthy diet and getting regular exercise in order to avoid high blood pressure. Other recommendations include avoiding blood thinners (ask your doctor before making any change in your medication), heavy lifting, and excessive alcohol.
A cavernoma is usually diagnosed when symptoms, such as a seizure, occur. Although the condition was identified in the 1930s, reliable diagnosis only became possible in the 1980s with the advent of magnetic resonance imaging (MRI). Wellstar physicians believe the MRI is still the best way to diagnose this illness. Depending on the conditions and location of the cavernoma, it may be necessary to take repeated MRI images to detect a change in size, recent bleeding or the presence of new lesions.
The malformations do not show up on an angiogram, which is a type of X-ray used to image the body’s blood vessels.
Tools and Tests
Wellstar neurosurgeons/neurologists use magnetic resonance imaging (MRI) with and without contrast to detect the presence of cavernomas. MRI uses a strong magnetic field and radio waves to produce cross-sectional images.
Sometimes a cavernoma will be discovered incidentally—that is, in the course of diagnosing another condition. If the lesion is not causing symptoms, your doctor may recommend following it with MRI scans. If the lesions are causing symptoms including seizures, medication may be recommended.
Surgery may be recommended if a cavernoma has recently hemorrhaged, expanded in size, is accessible or in some cases, is causing seizures that cannot be controlled by medication. One of the most important issues is to weigh the risk of brain or spinal cord surgery against the risk of further bleeding. Your Wellstar neurosurgeon will discuss these and other concerns with you and will explain what’s involved, the risks and possible outcomes.
Cavernomas are surgically removed (resected) via an opening in the skull. The procedure is usually performed under general anesthesia. The advent of microsurgery/computer-assisted navigation has made it much easier for neurosurgeons to remove cavernomas in the brain and on the spinal cord.
In some cases surgery can actually cure the disease by removing the lesions. In other cases the goal is to prevent future bleeding and related problems. As with any surgery there are risks and side effects that must be balanced against health improvements. These can include stroke, paralysis, coma or death.
Ongoing Care for Cavernomas
Many patients will be able to leave the hospital a few days after their surgery and resume regular activities within a few weeks with no resulting neurological problems. Some patients, including those with neurological problems, may require a period of rehabilitation. Wellstar offers comprehensive rehabilitation at several convenient locations. Our trained and compassionate physical, occupational and speech therapists help patients regain strength, skills and the ability to live normal and comfortable lives.
If you smoke, you should quit. Wellstar offers smoking cessation programs that educate people about smoking risks, encourage behavior modification to help minimize smoking urges and offer numerous coping strategies. Several different methods for changing smoking behavior are explored so that individuals learn approaches that work best for them.