Is a cavernoma serious?

Problems with the brain are always a worrying prospect. Our brains are, in a lot of ways, who we are, containing our memories and acting as the control centres of our bodies. A cavernoma is a condition of the blood vessels that can occur in the brain or spinal cord, and can even lead to bleeding in the brain. Are they serious? Leading neurosurgeon Mr Christos Tolias has the answers.

What is a cavernoma?

A cavernoma, also called a cavernous angioma, cavernous haemangioma, or cavernous malformation, is an accumulation of abnormal blood vessels found in the central nervous system – most commonly in the brain and spinal cord. These blood vessels are wide (cavernous, hence the name), and blood travels through them slowly. Cavernomas can range in size from just a few millimetres to several centimetres and usually look similar to raspberries. They are a type of arteriovascular malformation (AVM).

As many as 1 in every 600 people could have a cavernoma. The majority of cases are not hereditary and it is unusual to have more than one. However, some cases are thought to stem from a genetic predisposition, particularly in patients who have multiple cavernomas.

Symptoms of a cavernoma

Most cavernomas do not cause any symptoms, and may go unnoticed for most of (or even all of) the patient’s life. Most are found during scans carried out for other reasons.

However, in some cases they can cause symptoms, which can be very serious in nature and may post a serious risk to the patient’s health. Symptoms can include:

• Headaches
• Seizures
• Tiredness
• Memory problems
• Difficulty concentrating
• Weakness
• Loss of sensation in part of the body
• Dizziness/balance issues
• Slurred speech
• Double vision/blurred vision
• Tremor
• Bleeding (haemorrhage)

Each case is different, and the symptoms that present depend largely on where the cavernoma is located and how severe it is. Problems tend to occur when the cavernoma is putting pressure on certain parts of the brain or bleeding into it. Most haemorrhages are small and asymptomatic, but severe bleeding can potentially prove fatal, or could have long-term consequences for the patient’s health.

What causes a cavernoma?

The exact causes of cavernomas are poorly understood. Most cases seem to occur completely at random, but a minority of cases seem to involve a genetic predisposition.

Diagnosing cavernoma

MRI scans are generally the most effective test to diagnose a cavernoma, providing a detailed image of the brain and spine. CT scans and angiograms can also indicate the presence of a cavernoma, but show this less clearly than an MRI. The slow blood flow through a cavernoma means that it isn’t visible on an angiogram.

Cavernoma treatment

Treatment varies case by case, depending on the symptoms present, the severity of the symptoms, and the location of the cavernoma. As the majority are benign, conservative treatment is the norm.

• Watch and wait – if the patient is displaying no symptoms and the cavernoma does not appear to be causing any harm, the doctor will generally recommend no treatment, but will monitor the situation with regular check-ups.
• Medication – this helps to manage the symptoms, but does not affect the cavernoma itself.
• Neurosurgery – treating the cavernoma directly is not a decision that is taken lightly, and is recommended when the risks of not operating outweigh the risks of the procedure. A multidisciplinary team (MDT) of specialists will carefully plan the complex procedure.
• Non-invasive surgery – newer technologies such as GammaKnife and CyberKnife offer stereotactic radiosurgery. These non-invasive options may be used for cavernomas located deep in the brain, where invasive surgery carries higher risk or is downright impossible.

The available options are always thoroughly discussed with the patient beforehand, as are the patient’s own preferences.

After a patient has been successfully treated for a cavernoma, they will need regular check-ups with their doctor and further scans.

For more information or to book an appointment, visit Mr Tolias’s Top Doctors profile.