Cavernous Malformation

Specialty Area: Cerebrovascular

A cavernous malformation (CM) is an abnormal cluster of capillaries and venules that periodically bleed and give rise to a "popcorn-like" lesion in the brain or spinal cord with very thin walls that contains blood of different ages. CMs are also known as cavernoma, cavernous angioma, cavernous hemangioma or capillary hemangioma. They have also been called "angiographically occult" or "occult" arteriovenous malformations.

Symptoms:
Johns Hopkins estimates that less than one percent of people are born with a brain or spinal cord lesion that eventually becomes a CM. They can be hereditary, which means that they have been passed from the parents to their children. Most CMs declare themselves by causing seizures, headaches or with a large bleed.

Diagnosis:
We typically first find the CM in a computed tomography (CT) scan, or more commonly in a magnetic resonance imaging (MRI) scan. The appearance of the cavernous malformation on the MRI is very characteristic. An angiogram is usually not necessary.

Hopkins Treatment:
At Johns Hopkins, we treat CMs by microsurgical resection whenever indicated. Most CMs, however, do not need surgery and can simply be followed with yearly MRIs. During microsurgical resection, we perform a craniotomy and, using a microscope, remove the CM from the brain or spinal cord. We do not recommend stereotactic radiotherapy (also called “gamma knife” or stereotactic radiosurgery) as a treatment for CMs.