Cavernoma
A cavernoma, or cavernous haemangioma, is a vascular malformation in the brain or spinal cord made up of a cluster of abnormal, closely packed, thin-walled capillaries. These "mulberry-like" structures contain slow-moving blood and can leak small amounts of fluid, leading to headaches, seizures, or neurological deficits.
Symptoms
- New-onset seizures (the most common presenting symptom).
- Recurrent headaches, which can range from mild to severe.
- Focal neurological deficits (weakness, numbness, vision changes) depending on the cavernoma's location.
- Balance and coordination problems, especially with brainstem cavernomas.
- Symptoms caused by minor recurrent bleeding into surrounding brain tissue.
Clinical anatomical model showing affected spinal structures (no text). Causes and risk factors
- Congenital: most cavernomas are present from birth.
- Genetic mutations: about 20% of cases are hereditary, often causing multiple cavernomas (familial cavernous malformation).
- Sporadic cases, which typically present as a single isolated cavernoma.
- History of prior brain radiation therapy in rare instances.
How diagnosis is made
- Brain MRI (specifically gradient echo or susceptibility-weighted imaging) is the definitive diagnostic method showing the "popcorn" appearance.
- CT scan to detect acute haemorrhage or calcification.
- Catheter angiograms are typically negative (cavernomas are "low-flow" lesions).
Typical diagnostic grey-scale imaging scan (MRI/CT). Non-surgical treatment options
- Observation with serial MRI scans for asymptomatic or stable cavernomas.
- Anti-seizure medications to manage and prevent seizures.
- Avoidance of blood-thinning medications when clinically safe.
- Lifestyle modifications and regular clinical follow-up.
When surgery may be considered
Surgical resection (microsurgical excision) is considered for cavernomas that cause recurrent, drug-resistant seizures, progressive neurological deficits, or have caused multiple documented symptomatic haemorrhages, provided they are in a surgically accessible location.
Expected outcomes
Complete surgical removal of accessible cavernomas is highly successful, curative, and eliminates the future risk of bleeding and seizures. Brainstem or deep-seated cavernomas carry higher surgical risks and require careful multidisciplinary planning.
Rehabilitation pathways and safe movement restoration. Frequently asked questions
Can a cavernoma run in families?
Yes. In about 20% of cases, cavernomas are inherited in an autosomal dominant pattern. Familial cavernomas are often characterized by multiple lesions throughout the brain and require genetic counselling.