Cavernous Malformations

Cavernous malformations of the brain and spinal cord are lesions consisting of cysts ("caverns") filled with blood of different ages lined by an endothelial layer. Typically, there is no interposed normal brain parenchyma within the lesion. Cavernous malformations can present with seizures, hemorrhage, or symptoms of mass effect. With the widespread utilization of noninvasive imaging, incidental lesions are not uncommon. Cavernous malformations have usually a typical MRI appearance and other imaging modalities are rarely indicated. The risk of hemorrhage is related with their mode of presentation and, in symptomatic lesions, invasive treatment is indicated to prevent further bleeding and for seizure control in patients with epilepsy. Because of the very benign natural history, treatment is not indicated for asymptomatic lesions. The role of radiosurgery is controversial and this therapeutic modality should only be reserved for truly unresectable lesions that exhibit a very aggressive clinical course.